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United Way Pledge Form

Title:
First:
 MI:
Last:
Home Address: City: State: Zip:
Email Address: Daytime Phone: Company:
 United Way Community Fund Amount:
Giving Options
EASY PAYROLL DEDUCTION
I want to contribute the following amount each pay period:
$5 $10 $25
Other
Other $:
OTHER PAYMENT METHOD
Direct Gift to be paid by:
Cash
Personal Check
Credit Card
Amex, Discover, Mastercard, Visa
#:
Exp. Date:
MY GIFT OF $500 (or more)
Qualifies me for the membership in the Circle of Friends.
My name will be listed as it appears above.
I prefer that my gift remain anonymous.
List my name as follows:
DESIGNATION (OPTIONAL) ORGANIZATION:
$
I AM INTERESTED IN VOLUNTEERING
**501(c)(3) nonprofit in Antrim, Benzie, Grand Traverse, Leelanau and Kalkaska counties only
Under the law 100% of the donation recieved is tax deductable. Donors giving through payroll deduction, keep the confirmation email and your payroll stub for your tax records.
521 South Union Street, Traverse City, Michigan 49684
PH. 231-947-3200 | FX. 231-947-3201