Pledge Form - United Way Of Metro Chicago
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1PLEDGE FORM
1
GIVE. ADVOCATE. VOLUNTEER.
Please complete the required information so we may properly record your gift.
(Your privacy is important to us. Your information will not be sold.)
NAME
FIRST
MI
LAST
MR.
MRS.
MS.
n
n
n
HOME ADDRESS
DATE OF BIRTH (MM/DD/YYYY):
CITY
STATE
ZIP
/
/
–
–
PREFERRED PHONE
n
n
n
MOBILE
HOME
WORK
Year of my first United Way donation __________
PERSONAL EMAIL
WORK EMAIL
COMPANY
TITLE
Yes, I want to receive United Way’s e-newsletter featuring inspiring stories about how your investment is making Chicago a better place to live.
n
2
MY PLEDGE TO UNITED WAY:
YOUR GIFT CAN MAKE
$10,000
$5,000
$2,500
$1,000
$500
$250
$100
Other $_________
ALL THE DIFFERENCE
Tocqueville
Leadership Gifts*
Society
Choose one or more options below
$5,000
helps fund school parent
PAYROLL DEDUCTION
CHECK
n
n
mentors and community
Personal check made payable to United Way of
health educators for a year
$
pay periods = total gift.
Metropolitan Chicago (remit to address below).
per pay period x
$2,500
helps fund afterschool
SECURITIES/STOCK
CREDIT/DEBIT CARD
n
n
curriculum materials and
Make a secure credit card donation at
Call United Way of Metropolitan Chicago Major Gifts
sports equipment
or call 312.906.2204, and turn in this form to the appropriate
department at 312.906.2343 for details on how
person at your office.
to transfer.
$1,000
funds counseling and
MATCHING GIFT
n
Note here and contact your company Human Resources department for necessary documentation.
job readiness coaching
for a week
n
Yes, I want to join the fight for a better Chicago region. I choose to give 100% of my gift to
United Way of Metro Chicago to fight for the health, education, financial stability and safety
$500
covers doctor visits for
of every person in every Chicago region neighborhood.
5 people
OR
$100
n
pays for nutritious food
Yes, I want to participate in the United Way campaign for a better Chicago region and
from a pantry for a week
I choose to direct my gift in the following ways:
1
_____% EDUCATION
- Helping prepare students to graduate from high school and succeed
}
THE EXELON EDUCATION
A direct donation to our work will be
matched $1 for $1 up to $150,000 by Exelon
CHALLENGE GRANT
2
_____% STRONG NEIGHBORHOODS FOR A STRONGER CHICAGO
- Our new investment strategy
brings together the resources that support neighborhood leaders, residents, and organizations to create
thriving communities for all of us.
}
NICOR STRONG NEIGHBORHOODS FOR A
A direct donation to our work will be
matched $1 for $1 up to $65,000 by Nicor.
STRONGER CHICAGO CHALLENGE GRANT
3
_____% To another 501(c)(3)
(please note that a processing fee will be charged to direct your gift)
*
_____%
AGENCY NAME
PHONE
ADDRESS
O FFE R S COM P L IM ENTARY
S U BS C R IP TIO N S
3
n
Please list me/us as: (Examples: Mr. and Mrs. John Doe or John and Jane Doe)
Please recognize my gift as “Anonymous.”
n
Chicago Magazine is proud to
support the work of United Way
n
of Metro Chicago and for each
Please combine my gift with my spouse/partner’s gift.
direct gift of $1,000 or more, you
SPOUSE/PARTNER’S NAME AND EMPLOYER:
will receive a complimentary
annual subscription.
SPOUSE/PARTNER’S GIFT AMOUNT: $
Subscription starts 4-6 weeks
SIGNATURE
DATE
after close of workplace campaign
Required
tracking code:
TOP : UNITED WAY MIDDLE: COMPANY BOTTOM: DONOR
p
f
d
United Way of Metro Chicago
75 Remittance Drive, Suite 5828
@unitedwaychicago
@unitedwaychi
@unitedwaychi
Chicago, IL 60675-5828
2017/18
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