United Way Pledge Form - United Way Of Greater Greensboro

2017 UNITED WAY PLEDGE FORM

LIVE UNITED

MY CONTACT INFORMATION

FIRST NAME _____________________________ MIDDLE __________________ LAST __________________________________ SUFFIX _____

DR./MR./MS./MRS.

Required

Circle one

HOME ADDRESS _____________________________________________________ CITY/STATE/ZIP ___________________________________________________

Required

PHONE ( _____ ) ___________________________ EMPLOYER ____________________________________________________________________________________

q CELL q HOME q W O RK

PERSONAL EMAIL _________________________________________________________________________________________________________________________

Sharing your email enables us to send impact updates, special event invitations and billing statements.

FOR PUBLIC RECOGNITION

q Combine my gift with my spouse/partner

q Recognition Name(s)

___________________________________________

Name

If different than above

- OR -

q I/We prefer all my/our gifts to remain anonymous

Employer

A gift of $120+ to United Way of Greater Greensboro earns you special discounts

MY UNITED WAY INVESTMENT

at local restaurants and attractions with the Caring Club card!

PAY NOW

EASY PAYROLL DEDUCTION

Attach cash - $

A. Number of pay periods

Attach check made payable to United Way - $

(Payment processing will not start until your workplace campaign is submitted to United Way.)

B. Amount per pay period:

PAY LATER

q $100

q $50

We will bill you at the email address listed above. Payment can

q $25

q $10

be made via credit card, personal check or stock transfer.

(Donation must total $25 or more. Pledges less than $100 will be billed semi-annually.)

Other

Choose a billing preference:

Your final check stub for the year is your receipt.

q Monthly q Quarterly q Semi-annually q Once

TOTAL ANNUAL

Billing begins January 1.

TOTAL ANNUAL

PLEDGE (AxB)

PLEDGE

or choose start date:

I WANT TO BE MORE INVOLVED IN MY COMMUNITY!

I’M PLANNING FOR THE FUTURE!

Join a group and you will have access to volunteer opportunities, events

and social connections that help us break the cycle of poverty.

q I am already retired

q I plan to retire next year on:

q Young Leaders

(under age 40, annual contribution of $120+)

- AND/OR -

Women United

(annual contribution of $1,000+)

q I want to learn more about Planned Giving

q African American Leadership

(annual contribution of $1,000+)

q Tocqueville Society

(annual contribution of $10,000+)

MY SIGNATURE

DATE

Signature and date are both required for all methods of payment

Optional

FOCUS my gift in the most effective way to put children, adults and families on a path toward self-sufficiency.

OR CHOOSE ONE

area focused on helping others ($100 pledge minimum):

q Achieve education and character success.

q Designate to another nonprofit agency (see reverse side)

q Reach financial stability and independence.

(See reverse for information and fees related to processing gifts to funded partners.)

q Lead a healthy lifestyle.

q Access food and other basic needs.

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 employer

document showing the amount withheld and paid to a charitable organization. Consult your tax advisor for more information. (Financial information about this organization and a copy of its

license are available from the State Solicitation Licensing Branch at 919-807-2214 or 888-830-4989 for NC Residents.)