United Way of Buffalo & Erie County Pledge Form United Way Customer Service: 716-887-2758 or [email protected] HOW CAN WE REACH YOU? MR/MRS/MS/DR FIRST NAME MI LAST NAME HOME ADDRESS CITY STATE PHONE: ■ HOME ■ CELL ZIP WORK PHONE EXTENSION EMPLOYER NAME EMPLOYEE NUMBER (IF APPLICABLE) E-MAIL ADDRESS ■ Personal ■ Work: We will e-mail you confirmation of your pledge and information on how your gift is making a difference. Your privacy and confidentiality are important to us. We never share your information. HOW WOULD YOU LIKE TO GIVE? ■ EASY PAYROLL DEDUCTION (please complete A, B and C) A. How much would you like to give per pay period? ■ $50 ■ $25 ■ $10 ■ $5 ■ Other $ B. How often are you paid? ■ Weekly (52 pay periods per year) ■ Every other week (26 pay periods per year) ■ Twice a month (24 pay periods per year) ■ Monthly (12 pay periods per year) ■ Other ( pay periods per year) C. What is your total gift? (multiply the number of pay periods by the amount you wish to give per pay period) OPTIONAL WHERE DO YOU WANT YOUR GIFT TO GO? OR ■ DIRECT GIFT Total gift: $ to be paid by: ■ Check #: ■ Bill me starting: (made payable to “United Way”) ■ Monthly ■ Quarterly ■ One time / ■ Cash Leave this section blank if you want your gift to be combined with thousands of others to make the greatest impact in Education, Financial Stability and Health & Wellness in Buffalo & Erie County. If you want to direct all or a portion of your gift to another organization, do so below. ■ I want to support United Way’s work in another community: AMOUNT $ ■ Credit card ■Automatic bank deductions (we will mail you a separate form) ■ Stock option UNITED WAY IN (CITY/STATE): And/or Total Annual Gift: A gift of $500 or more automatically enrolls you in the United Way Leadership Society. Visit uwbec.org/leadership for details. ■ I want to support another organization1: AMOUNT $ AGENCY NAME: Signature Date ADDRESS: CITY/STATE: THANK YOU FOR YOUR SUPPORT Please make a copy or take a photo of your completed Pledge Form for your tax records. UW-14 The United Way of Buffalo & Erie County does not provide goods or services as whole or partial consideration for your contribution. ■ Please do not release my name to the agency. Please use the reverse side of this form to make additional designations. 1 The full list of agencies eligible to receive designations in the 2014 Campaign is available by visiting www.uwbec.org/donordesignation.