MY PERSONAL GIFT AMOUNT: *

All entries from below should total to this amount.

STEP-UP PROGRAM (if applicable):

All entries from below should total to this amount.

MY TOTAL TOCQUEVILLE GIFT AMOUNT: *

All entries from above should total to this amount.

Please direct my gift where it’s needed most :

A gift to United Way of Central Maryland improves lives for residents of Greater Baltimore and the surrounding counties by promoting equity and increasing access to education, health, economic advancement, and housing.

United Way of Central Maryland (4444)

I want to direct my gift to United Way of Central Maryland’s impact areas:

211 Maryland United Way Helpline (899)

Education Programs (6381)

Economic Advancement Programs (2666)

Housing Programs (3338)

Health Programs (4743)

Additional opportunities to give back:

Neighborhood Zones (9081)

Equity & Social Justice Fund (287)

Veterans Treatment Court (9080)

Give to a United Way geographical location:

Anne Arundel County Fund (7686)

Baltimore City Fund (7602)

Baltimore County Fund (7612)

Carroll County Fund (7687)

Harford County Fund (5756)

Howard County Fund (3709)

I want to support another nonprofit:

Agency Name:

Agency Address:

If donating to another nonprofit, this field is required.

Designation Amount:

This form is limited to one agency designation. Would you like to be contacted to designate to additional agencies?

Yes. I would like to be contacted to designate to additional agencies. No.

Other:

Recognition by agency. Please select if you would like to remain anonymous.

Yes. I wish to remain anonymous. No. Please feel free to release my name to the designated agencies.

I wish to leverage my gift in the Step-Up Program. Learn more at uwcm.org/WhyGive.

Yes. I wish to leverage my gift.

1. Payroll Deduction:

I would like to donate through payroll deduction.

Amount per pay period

Amount per Year:

2. Pay by Check:

I would like to send by donation by check.

Check number:

Check Amount:

Please make your check payable to United Way of Central Maryland and then mail to:

United Way of Central Maryland

Attn: Major Gifts

P.O. Box 64282

Baltimore, MD 21264-4282

3. Invoice:

I would like United Way of Central Maryland to bill me.

Bill me starting on:

Amount:

Bill me either:

Monthly Annually

4. Credit Card

I wish to pay by credit card.

Amount:

USD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

To fulfill your Tocqueville Society pledge by credit card, please click here to enter your card information. Please remember to submit this form as well.

5. Securities & Stocks

I wish to donate securities & stocks as my gift.

For more information on donating stock, please contact Donor Services at 410-895-1432 or visit uwcm.org/stock.

Multi-Year Giving Option

Make a contribution that sustains the work of United Way with the ease and convenience of a multi-year gift that benefits the community year after year.

Annually, you will receive a gift reminder with payment options.

2020 Multi-year giving amount:

2021 Multi-year giving amount:

2022 Multi-year giving amount:

Learn why personal information is collected and how it’s protected: uwcm.org/privacy-policy.

Your Full Name: *

Prefix First Name M.I. Last Name Suffix

Home Address: *

Street Address

Street Address Line 2

City State

Zip Code

Personal Email Address:

Please enter your personal email address.

Phone Number:

Please enter a valid phone number.

Birth Year:

Please enter the 4-digit year you were born.

Identity:

Company Name:

Work Email Address:

Work Phone Number:

Work Ext. Number (if applicable):

Please recognize my/our name(s) as:

Combine our gifts:

I would like to combine gifts for purposes of recognition. I've indicated my partner's name and employer here.

My Partner's Name:

First Name M.I. Last Name Suffix

Partner's Company Name:

Combined Gift Total:

Women United-Tocqueville Society:

Please include me or my partner in the Women United-Tocqueville Society. (Gifts can also be made in the name of or to honor women at the $10,000 level.)

Dix Années Société:

I/We have been giving at the Tocqueville Society level for at least 10 consecutive years and would like to be recognized as a Dix Années Société member. I/We have been giving at the Tocqueville Society level since:

Input year of giving at Tocqueville Society level:

Please enter a 4-digit year

LEGAL INFORMATION: Contributions to United Way of Central Maryland, Inc. (UWCM) are tax deductible within the limits of current federal and Maryland state law. UWCM has provided no goods or services in exchange for your contributions. You will be acknowledged for direct contributions made during the calendar year. United Way will send those acknowledgments before January 31 of the following year. To ensure receipt of your acknowledgment, please provide us with your full home address. If your contribution is being made by payroll deduction, you should keep a copy of this form which, along with your pay stubs or other documents furnished by your employer, show the amount withheld for your contribution and will provide the necessary support for your contribution for federal income tax purposes. UWCM does not provide goods or services in return for any contribution made to it by payroll deduction. A copy of the most current financial statement is available upon request by contacting UWCM. Documents and information submitted to the State of Maryland under the Maryland Charitable Solicitations Act are available from the Office of the Secretary of State for the cost of copying and postage. By providing your email address to United Way, you are opting in to receive periodic email communications from UWCM.

Full Name:

Date

Your Signature:

Clear

THANK YOU FOR YOUR SUPPORT!

Questions? Contact Jeff Pratt at

410-895-1526 or jeff.pratt@uwcm.org.

MY TOCQUEVILLE GIFT:

Please direct my gift where it’s needed most :

Give to a United Way geographical location:

I want to support another nonprofit:

Other:

PAYMENT OPTIONS:

MY INFORMATION:

SIGN & DATE

THANK YOU FOR YOUR SUPPORT!