United Way Pledge Form - Harrison County, West Virginia
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1REACH OUT A HAND TO ONE AND INFLUENCE THE CONDITION OF ALL
United Way
of Harrison County, Inc.
•
•
301 W. Main St, Suite 608, Clarksburg, WV 26301
Phone: 304.624.6337
United Way Pledge Form
_______________________________________________ _______________________________________________
MR/MRS/MS/DR
NAME ( please print clearly )
HOME ADDRESS ( For credit card charges, address listed must be your billing address. )
_______________________________________________
________
______________
__________________
CITY
STATE
ZIP CODE
HOME PHONE
______________________________________________________________________
__________________
COMPANY NAME
DAYTIME PHONE
_______
I have been contributing for
years. Please register me as a United Way
Loyal Contributor.
I am interested in volunteer opportunities with:
United Way Leadership
United Way Events
United Way Agencies.
_____________________________________
Please send me your ENewsletter and Save-the-Date Special Event Notices
HOME EMAIL ADDRESS ~ (You may opt-out at any time…)
STONEWALL JACKSON
PAYROLL DEDUCTION
DIRECT GIFT
LEADERSHIP CLUB
MY GIFT OF $500 OR MORE
EASY PAYROLL DEDUCTION
DIRECT GIFT
qualifies me for membership in the
Total Annual Gift
Total Annual Gift
Stonewall Jackson Leadership Club.
$
$
Please list name/names as
written above…
Payment Method:
I will contribute the following
My Spouse/Partner is also a
each pay period:
Cash
Personal Check
(enclosed)
contributor and our combined gift
qualifies us for membership.
Credit Card
($50 Minimum)
$50
$25
$10
$5
Please include our names as:
Card # ________-________-________-________Exp.____/____
OTHER AMOUNT
_______________________________
Bill me One Time
________/________
(month/yr)
$
Spouse/Partner Name & Employer:
Bill me Monthly beginning ________/________
______________________________
Bill me Quarterly
beginning ________/________
______________________________
Securities
# _________ Pay Periods
(# of deductions)
(Please call 304.624.6337 when you are ready to transfer funds.)
Please include me Anonymously.
UNITED WAY COMMUNITY IMPACT FUND
The most e ective way to invest in the needs of our community. Community Volunteers carefully allocate your
contribution to programs where help is needed the most.
Direct my gift to a United Way Member Agency, United Way Initiative, another United Way organization or any registered 501(c)3
DIRECT DESIGNATION
non-pro t organization of my choosing. Organization/Agency______________________________________________Amount________________________________
Signature (
_________________________________________________________Date__________________________
required)
Thank You...for your contribution through the United Way Campaign. No goods or services were provided in exchange for this Contribution. The
expenses associated with processing donor-designated pledges are recovered by an assessment for both fundraising and management and general fees on
actual historical costs in accordance with United Way Worldwide Membership Standards.
White ~ Employer
Yellow ~ United Way
Pink ~ Contributor
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