United Way Pledge Form - Orange County, California Page 2
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1
2PLEDGE FORM
Orange County United Way
1. ABOUT YOU
(Please Print)
Mr.
Mrs.
Ms.
First Name
M.I.
Last Name
Home Address
City
State
ZIP
Mobile Phone
Home Email
By including your email address, you will receive information about the impact of your donation and opportunities to be more involved in your community.
Let us know if you have a specific area of interest (We do not rent, trade, or sell our donor list).
Education
Health
Housing
Financial Stability
ACKNOWLEDGMENT
Please list my donation to recognize my gift and to inspire others to give. Use the following acknowledgment:
Individual Names or Family
I wish to remain anonymous. This means my name will not appear on printed materials or Orange County United Way’s website.
EMPLOYER DATA (if applicable)
Employer Name
Employee ID#
Location/Department
2. YOUR GIFT
My gift to Orange County United Way
When we are UNITED4OC, we change the lives of adults and children right here in Orange County.
My gift to Orange County United Way will support the fight for the four most critical, interconnected needs
$
.
in our community—Education, Health, Housing and Financial Stability.
Additional gift
(other Nonprofit agency) – $120 minimum per organization
city
Name of the other agency
For gifts to other nonprofits that qualify as 501(c) (3) tax deductible and Patriot-Act compliant organizations, a processing fee
$
.
of 9% will be applied. If you checked the box to remain anonymous, your name will not be provided to the designated agencies.
$
.
My Total Gift
3. PAYMENT METHOD
Here is my pledge. Please check the appropriate boxes.
EASY PAYROLL DEDUCTION
OTHER PAYMENT OPTIONS
$
.
Cash (amount enclosed)
$
X
= $
Check #
$
.
(payable to Orange County United Way)
Credit Card (amount)
$
.
Amount per
Number of Pay
My Total Payroll
(minimum annual contribution $120)
Pay Period
Periods in Full Year
Deduction Gift
In Full
Quarterly If left blank, the contribution will be charged in full.
Name on Card
Credit Card #
Exp. Date
Month
Year
X
Signature Required
Date
Return the white copy to United Way. The blue copy to your employer. Retain the amber copy for yourself.
Orange County United Way -18012 Mitchell South, Irvine CA 92614 - 949.660.7600 - - TAX ID# 33-0047994
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