United Way Pledge Form - Cecil County, Maryland

reAch out A hAnd to one And Influence the condItIon of All

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®

United Way

of Cecil County

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united way Pledge form

Mr/Mrs/Ms/dr

FIrsT NAMe

MI

LAsT NAMe

o

I’d like to hear from united way about

HOMe Address (For credit card charges, address listed must be your billing address.)

cITy

how my contribution is getting results.

sTATe

ZIP

HOMe PHONe

dAyTIMe PHONe

cOMPANy NAMe - reqUIred FOr PAyrOLL dedUcTION

want to see how your contribution is making a difference?

Please provide your home email address so we can show you how your contribution is

making a difference and provide opportunities to give, advocate and volunteer all year long.

*

HOME EMAIL ADDRESS

PleAse select PAyroll deductIon or A dIrect gIft.

o

o

o

EASY PAYROLL DEDUCTION

DIRECT GIFT

MY GIFT OF $750 OR MORE

qualifies me for membership in the Name of

My total annual gift

Leadership Giving Circle. My name will be

AMOUNT $

listed as it appears above.

AMOUNT $

Direct gift to be paid by:

AMOUNT $

A.

I want to contribute the following

❍ cash

amount each pay period:

❍ Personal check (enclosed) Please make check pay-

❍ Please list my/our name(s) as follows:

❍

$50

❍

$25

❍

$10

❍

$5

able to:United Way of cecil county

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other $

❍ credit card

❍ Visa ❍ Mastercard ❍ American express

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

B.

I pledge

% of my salary, for

card Number

a total gift of $

❍ I prefer that my gift remain anonymous.

expiration date

PleAse choose how you wAnt to Invest In your communIty.

option A

Influence the condItIon of All.

United Way Community Care Fund.

o

The most powerful way to invest your contribution.

AMOUNT $

option B

successful chIldren And

o heAlth And wellness

o IndePendent lIvIng

o overcomIng crIsIs

o

fAmIlIes

• Increasing access to critical

• Providing new and increased

• Supporting basic needs

healthcare services

services to our aging population

• Improving access to quality,

• reducing substance abuse,

affordable child care and early

child abuse and domestic violence

learning opportunities

• Increasing health education

• Providing after-school and mentoring

and preventive care

programs for at-risk youth

AMOUNT $

AMOUNT $

AMOUNT $

AMOUNT $

option C

o

Designated Contribution

AgeNcy NAMe ANd Address (Or AgeNcy cOde)

AMOUNT $

Please check the accuracy of all your entries.

Signature

Thanks for investing in United Way of Cecil County.

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