United Way Pledge Form

United Way of Aroostook

PLEDGE FORM

STEP 1:

TELL US ABOUT YOURSELF

Mr. Mrs. Ms. or Dr.

First Name

M.I.

Last Name

Home Address

City

State

Zip code

Name of Workplace

Preferred Phone

o Home o Cell o Work

Preferred Email

o Personal

o Work

o COMBINE MY GIFT

o I AM A NEW DONOR

o I WANT TO VOLUNTEER

o I AM A LOYAL DONOR

Please combine my gift with

This is my first donation to

I want to offer my time to

United Way of Aroostook

advance local community

my spouse:

building efforts

STEP 2:

SELECT YOUR PREFERRED PAYMENT OPTION

o EASY PAYROLL DEDUCTION

o DIRECT GIFT

o ENDOWMENT AND PLANNED GIVING

I want to contribute the following

Secure the future now. When you commit

Please write the amount below and

yourself to our endowment and planned

amount each pay period for a full year.

indicate your preferred giving method.

giving fund you guarantee our ability to

MY GIFT PER PAY PERIOD

respond to the changing landscape of

Aroostook County. With your help we can

$20

$10

$5

DIRECT GIFT TO BE PAID BY:

o

o

o

build capacity for both present and future

$3

Other

o

o

needs for generations to come.

Cash

o

Personal Check (Enclosed)

o

MY

TOTAL

ANNUAL GIFT

Check the box above if you'd like more

Securities *

o

information about our Endowment and

x

=

Credit Card *

o

Planned Giving Fund.

Bill Me

o Monthly o Quarterly

o

Gift Per Pay Period

Pay Periods Per Year

Total Annual Gift

*Call 207-764-5197

A gift of $520 or more qualifies you for recognition as a Leaders' Circle donor. If your spouse or partner gives separately, you may combine your gift to qualify.

I wish to remain anonymous.

Please list my / our names as follows in the Leaders' Circle registry:

o

o

STEP 3:

PLEASE CHOOSE HOW YOU WANT TO INVEST IN YOUR COMMUNITY

A

INFLUENCE THE CONDITION OF ALL.

o

AMOUNT $

I wish to remain anonymous.

o

B

o

PLEASE PRINT 501(c)(3) NAME

Please designate my funds to this 501(c)(3)

AMOUNT $

o

Please release my name to the 501(c)(3) to acknowledge my gift.

STEP 4:

PLEASE GIVE US YOUR SIGNATURE

THANK YOU!

Please check the accuracy of all your entries.

Signature

Thanks for investing in United Way.

Thank you for your contribution through the United Way campaign. No goods or services were provided in exchange for this contribution. Please keep a copy of this form for your tax records. You will

also need a copy of your pay stub, W-2 or other document showing the amount withheld and paid to a charitable organization. Consult your tax advisor for more information.

United Way of Aroostook | 830 Main Street, Suite 4 Presque Isle, ME 04769 | (207) 764-5197 |