Pledge Card First Middle Last Company Email Phone Address City State ZIP Code Donation Method Preferred Donation Method Payroll Deduction Check Cash Bill Me Credit Card Payroll Deduction Contribution Amount Per Pay Period $5 $10 $20 $25 $50 Other… Please enter the NUMBER only $ Number of Pay Periods for Donation One Time 12 pay periods 24 pay periods 26 pay periods 52 pay periods Other… Please enter the NUMBER of pay periods for this donation Check Donation Amount of Check $ Please give the check to your Campaign Coordinator within 24 hours of this pledge. Cash Donation Amount of Cash $ Please give your cash donation to your Campaign Coordinator within 24 hours of this pledge. Bill Me Details Frequency of Invoice One Time Quarterly Monthly Amount of EACH direct bill $ Credit Card Donation Amount of your One Time Donation $ After completing this form you will be redirected to our payment page where you will be able to process your transaction in a secured environment. Please be sure to enter the same values that you have entered on this form. Thank you! Total Annual Contribution Total $ 0 Update Donation Details Designation Options United Way Community Impact Fund Let United Way volunteers administer funds to the greatest needs in our community. Youth Opportunity Healthy Community Financial Security Community Resiliency Mark all that apply I am a leadership donor I'm interested in being a board member I wish to remain anonymous Agreement My signature below, confirms my pledge as stated above. Signature Sign above Proceed to Payment Page Submit Leave this field blank
