PLEDGE CARD Preferred Donation Method Payroll Deduction Check Cash Credit Card / Debit / Bank Transfer Payroll Deduction Contribution Amount Per Pay Period $5 $10 $20 $25 $50 Other… $ Number of Pay Periods for Donation One Time 12 pay periods 24 pay periods 26 pay periods 52 pay periods Other… $ My organization's Human Resources Contact Name (this is important for United Way to coordinate your pledge with the person in charge of your payroll). HR Email Address HR Phone Number TOTAL: $0 Check Donation Amount of Check $ Cash Donation Amount of Cash $ Credit / Debit Card Donors: Thank you for your support of the United Way. To complete your donation by credit or debit card - Click Here Your Name Title First Middle Last Suffix Your Contact Information Company Email Phone Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP Code Designations Invest My Donation In... General Fund Assists the greatest needs in our community. Education Fund Supports education in our community. Financial Stability Fund Supports financial stability related programs in our community. Health Fund Supports health related programs in our community 2-1-1 Fund Supports basic needs in our community Dolly Parton's Imagination Library Other nonprofit agency Enter other… Agreement My signature below, confirms my payroll deduction request as stated above. Signature Sign above Leave this field blank
