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ALLOTMENT DONATION
Allotment Donation
First Name
*
Last Name
*
Rank
*
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SSN
*
*
Email
*
*
*
Army Group
*
Active Duty/Regular Army
Retired
Active Guard Reserve (AGR)
Army Reserve
Army National Guard
Dependent
Other Branch
Not Eligible
Duty Status
*
Active Duty
Deceased - Active
Retired
Deceased - Retired
Gray Area Retired
AGR (Active Guard Reserve) (Title 10)
AGR (Active Guard Reserve) (Title 32)
Reservist (Title 10)
Reservist (Title 32)
Reservist (TPU)
Reservist (IMA)
National Guard (Title 10)
National Guard (Title 32)
National Guard (TPU)
Dependent Spouse
Dependent Child
Survivor (Deceased-Active)
Survivor (Deceased-Retired)
Not Eligible for AER
Originating Campaign
*
Other Installation
*
AER Section
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Unit (Optional)
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Pledge Amount (per month)
*
*
Frequency (months)
*
*
*
Allotment Start Date (date/time)
*
Auto-Renewal
Auto-Renewal
No
Auto-Renewal
Yes
I would like to receive Text Message (SMS) communications from AER
I would like to receive Text Message (SMS) communications from AER
No
I would like to receive Text Message (SMS) communications from AER
Yes
Cell Country Code
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Cell Phone
*
Portal Created
Portal Created
No
Portal Created
Yes
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