2024 TEST PAGE

Workplace Pledge Card

Prefix

First

Middle Initial

Last

Please tell us what name(s) to use when we thank you in recognition materials (Ex. John & Jane Smith)

Contact Information is not shared or sold. Please review UWGBACC's Privacy Policy as needed.

Contact Information

Email

Phone

Home Address

City/Town

State/Province

ZIP/Postal Code

Date of Birth

I'm Retiring (Month/Year)

I wish to remain anonymous

Yes

No

Would you like to be contacted about volunteer committees with United Way? If so, please let us know which position interests you:

Community Impact Committee

Events Committee

Finance Committee

Payroll Deduction

Investment Amount Per Pay Period

$250

$150

$75

$50

$25

Other…

Please enter the Amount per Pay Period $

Your Employer's Pay Periods per Year:

1 (One-Time Donation)

12 (Monthly)

24 (Bi-Monthly)

26 (Bi-Weekly)

52 (Weekly)

Other…

Please enter the NUMBER of pay periods for this donation

Total Annual Contribution

TOTAL: $ 0

Donation Details

Click here to view our current Funded Partner Agencies list, and please review our full guidelines in the Designation Policy before proceeding.

OPTIONAL You can choose your preferred donation area(s)

Invest my donation where it is needed most

Community Impact Fund

Education Fund

Financial Stability Fund

Health Fund

Basic Needs Fund

Please designate my investment to a different United Way service 501(c)(3) organization

• Designations must be a minimum of $100. • A designation fee of 5% will be applied. • If the designation agency is not easily identified by the information provided, is not a registered 501(c)(3), does not certify as Patriot Act compliant, is no longer in operation, does not meet the minimum requirement, and/or does not cash any checks within one year, your gift will go to where it is needed most in our local community.

Amount per Year to the Community Impact Fund $

Amount per Year to the Education Fund $

Amount per Year to the Financial Stability Fund $

Amount per Year to the Basic Needs Fund

Amount per Year to the Health Fund

Amount per Year to Another 501(c)(3)

501c3 Organization (Other United Way or Agency)

Name of Organization

Federal Tax ID#

Street Address

City

State

Zip Code

Organization Phone Number

Agreement

My signature below, confirms my pledge as stated above.

Signature

Status message