Workplace Giving Form

Employer *

Name *

First Name Last Name

I will be retiring this year:

Email

example@example.com

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Birthday:

Giving Option *

Specific Amount: *

Fair Share Pledge - (1 Hour pay per month x12 mo.) $4 / pay $6 / pay $12 / pay $25 / pay Other

Payment method

Check Credit Card Cash

I would like to make a one time contribution of $one time donation to support my community.

My donation *

USD Description

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Investment Options

I want to make the most powerful contribution possible. Please invest my contribution in all four (4) United Way Community Impact Areas to make my community a stronger and safer place to live Basic Needs Elderly Citizens & Adults with Disabilities Medical Assistance/ Health Care Programs Youth Programs Specifc Care ($50.00 minimum pledge required per agency). Must be a 501(c)3, health & human service organization serving Marquette County or a United Way. All gifts will be forwarded as you specify after a deduction for uncollected pledges and campaign costs.

Agency Name:name*.

How would you like to be thanked?

Nothing , seeing the community thrive is all the thanks I need! Mail Email

I am a Leadership Donor ($500+ annual giving) and would like to be acknowledged:

Yes No

For acknowledgement I would like my name to appear as: Name*

Signature *

Clear

No goods or services from The United Way of Marquette County are provided in whole or in partial consideration of your contributions. 100% of your contribution goes to the United Way of Marquette County. A copy of our official 501(c 3) registration may be obtained from the Attorney General’s Charitable Trust Division at 517-373-1152 or https://www.ag.state.mi.us/CharitableTrust/frmDisclaimer.aspx. Our EIN is 38-1358204. Registration does not imply endorsement, approval, or recommendation by the state.