Employee Pledge Form - United Way
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2LIVE UNITED
United Way of Greater McHenry County
Employee Pledge Form
MY INFORMATION
Please print
________________________________________
___________________________________________________________
q
q
q
q
MR.
MRS.
MS.
DR.
FIRST NAME
LAST NAME
_____________________________________________________________________
___________________________________________________________
HOME ADDRESS (for credit card charges, address listed must be your billing address)
CITY
______
_______________
_______________________________
____________________________________________________________________
ST
ZIP
PHONE
COMPANY NAME
____________________________________________________________________________________________________________________________________
EMAIL ADDRESS (receive occasional updates on how your gift is making an impact)
MY GIFT TO THE COMMUNITY
q PAYROLL DEDUCTION
q CREDIT CARD
I want to contribute the following amount each pay period.
q
Visa
q
MasterCard
q
Discover
q
American Express
q $40
q $20
q $10
q $5
q $2
q Other ( ______ )
Name on card ____________________________________________
I have ____________ pay periods each year.
Card # __________________________________________________
(12, 24, 26, 52, etc.)
Expiration Date _______________ Verification Code ___________
q DIRECT GIFT
Billing/Charge Schedule
Cash (enclosed)
q
One Time
Monthly
Quarterly Start Date ____________
Check (made payable to United Way of Greater McHenry County)
q
q
q
q
MY TOTAL GIFT $
q
I would like a receipt for my Direct Gift / Credit Card donation
PLEASE CHOOSE HOW YOU WANT TO INVEST IN YOUR COMMUNITY
q UNITED WAY OF GREATER MCHENRY COUNTY COMMUNITY FUND
The most powerful way to invest your contribution.
I’m interested in helping determine how United Way allocates its funds. Please contact me with more information.
q
q THE FOLLOWING UNITED WAY OF GREATER MCHENRY COUNTY PARTNER AGENCY
$52 minimum designation per partner agency. See back for partner agency codes and program information.
Code # ________________________
% of Gift ____________________
Code # ________________________
% of Gift ____________________
q THE UNITED WAY SERVING MY HOME COMMUNITY
$52 minimum designation.
Please provide ZIP code or city and state ___________________________
q
I prefer that my gift remain anonymous.
MY AUTHORIZATION
Required
Signature ________________________________________________________________________________________________ Date ____________________
THANK YOU!
United Way of Greater McHenry County, Inc. (UWGMC) is an Illinois not-for-profit 501 (c)(3) corporation exempt from federal income
tax. No goods or services are provided by UWGMC to you in consideration, in whole or in part, of your gift stated above.
White - UNITED WAY
Yellow - EMPLOYER
Pink - DONOR
United Way of Greater McHenry County | 4508 Prime Parkway, McHenry, IL 60050 | 815-363-1377 |
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Parent category: Business