HomeMy WebLinkAboutUnited Way Pledge Form
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I WANT TO MAKE AN IMPACT TODAY!
You can choose to designate all or a portion of your pledge to a 501(c)(3) organization of your choice. We ensure each organization meets
the Patriot Act and is in good standing with the IRS and State of Washington.
YES! I pledge to strengthen my community by improving the lives of children
and families in Benton & Franklin Counties.
REQUIRED FOR AUTHORIZATION.
MY INFO
FIRST NAME MIDDLE INITIAL LAST NAME
___________________________________________________ _____________ _____________________________________________________________
EMPLOYER EMPLOYEE ID
___________________________________________________ ___________________________________________
HOME ADDRESS CITY STATE ZIP___________________________________________________ __________________________________________ __________ _______________________
PERSONAL EMAIL CELL PHONE
( )___________________________________________________ ______________________________
Please tell us what name(s) to use to when we thank you in recognition materials: (Ex. John & Jane Smith)
I wish to remain anonymous. Please do not
use my/our names for recognition purposes.
CONTRIBUTION OPTIONS
OPTIONAL
Visa Mastercard Discover AMEX
SIGNATURE DATE
We use contact information to process gifts and occasionally tell you about your impact; we will not share it.
Agency Name __________________________________________________________________ City __________________ State _________
$_________
03/24
uwbfco.org | 401 N. Young St., Kennewick, WA 99336 | 509-783-4102
Please designate to the 501(c)(3) organization below.*Do not release my/our names to agency below.
Donor: Please make a copy for your records and return original to your Campaign Coordinator. Campaign Coordinator: Please provide original to payroll before forwarding to United Way.
* If you choose an organization that does not have current 501(c)(3) status,
or if we have tried to contact you about your designation and are unable to
reach you, your gift will default to our Community Impact Fund.
Your support helps
bridge the gap to
improve local lives.
Mail PhoneEmail
Thank you for your donation. To support claiming charitable contributions, consult your tax advisor and keep a copy of this form. If your donation is made through payroll you will also need a copy
of your paystub, W-2 or other employer document showing the amount withheld and paid to the charitable organization. No goods or services were provided in exchange for this contribution.
Tax
Records
Form Distribution
PAYROLL DEDUCTION
Card # __________________________________ Expires ___________ CVV ___________
CREDIT/DEBIT CARD
Please make checks payable to United Way of Benton & Franklin Counties.
GIFT ENCLOSED BILL ME
One Time Quarterly Monthly
Total: $___________________________________
Cash $ _____________________________
Check $ ___________________________ Check # ___________________________
Total: $___________________________________
One Time Quarterly Monthly
Mailed (address under “my info” section must be filled out)
Email to ______________________________________________________
Total: $___________________________________
Donation per pay period: $5 $10 $25
$50 $100 Other _________________
Pay periods per year: 12 (monthly) 24 (bi-monthly)
26 (bi-weekly) Other ___________________
Total: $___________________________________