2022 Online Pledge Form

Your pledge form will be filled out in 5 steps:

1. Donor information - Your personal information is confidential and is never sold or shared.
2. Gift amount and payment method.
3. Leadership Giving - Skip this section if your pledge is less than $500.
4. Choose how you want to invest in your community.
5. Initial and date your pledge.

Employer

Full Name

Home Address

City, State, Zip

Home Phone

Cell Phone

Work E-mail

Personal E-mail

Preferred Contact

What is your age range?

Are you interested in volunteering?

Would you liked to be added to our e-mail list?

Would you like to be added to our text list?

How will you be paying?

Your TOTAL annual gift

If you are paying by Bill Me, how often would you like a bill?

If paying by payroll deduction, how much is being withheld from each pay period?

If paying by payroll deduction, what is your pay period schedule?

Your gift of $500 or more qualifies you for membership in the Leadership Giving Society.

I prefer that my gift remains anonymous.

My gift combined with my spouse qualifies us for a leadership level:

Please use my gift where it is needed most.

I wish to designate all or some of my gift to one or more United Way Partner Agencies or another United Way:

Today's Date

I prefer to be thanked by

I have included or will include United Way in my estate plans.

Initial

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