WIREGRASS UNITED WAY EMPLOYEE PLEDGE FORM

WIREGRASS UNITED WAY EMPLOYEE PLEDGE FORM

September 4 - September 26
MY INFORMATION.

Please print and sign at the bottom of the form. Your information, including your email, is never shared.
Company Name
Your Name
Employee Number
Phone
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
weeklyevery other weekmonthlytwice monthly
Preferred Email Address
example@example.com
MY UNITED WAY INVESTMENT.

Please select your method of contribution.
Fair ShareDirect BillPayroll DeductionOne Time Cash or Check ContributionETO Deduction
FAIR SHARE

When you check one of the boxes below to give one hour or one percent of pay per month to the WUW, you’re choosing to give at the Fair Share level. All Fair Share donors will receive a Fair Share Discount Card in appreciation for your gift. If you don’t know your exact hourly rate or percentage, simply check the box below and your payroll department will fill in the amount.
One hour of pay per month
Amount
One percent of pay per month
Amount
TOTAL YEARLY PLEDGE
Completed by payroll department. (Hourly Rate x 12 = Total Yearly Pledge)
Choose Another Amount
Amount per pay period
One time Deduction Amount
ETO Deduction
TOTAL YEARLY PLEDGE
($ Amount x # of Pay Periods = Total Yearly Pledge)
Check here if your donation is at or above Fair Share level
DIRECT BILL
Home address required. $100 minimum donation. All direct bill statements are mailed on a monthly basis until pledge is fulfilled.
Total Yearly Pledge
CASH OR CHECK
Cash
Check
Please make checks payable to Wiregrass United Way.
If you wish to designate your gift, write in the name of the agency below. A minimum pledge of $50 per agency is required to designate.
(Agency)
Amount
(Agency)
Amount
MY SIGNATURE
Date

MonthDayYear
Date
Your contribution is fully tax deductible. No goods or services were provided in exchange for this contribution.

Clear
Should be Empty:

WIREGRASS UNITED WAY EMPLOYEE PLEDGE FORM

MY INFORMATION.

MY UNITED WAY INVESTMENT.

Choose Another Amount

DIRECT BILL

CASH OR CHECK

MY SIGNATURE