United Way Pledge Form

Investing in youth programs that positively impact social, emotional, and mental development.
My Information
Your Name*

First NameMiddle NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your E-mail*
example@example.com
Home Phone

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Employer Name*
YesNo
Union Name & Number
My Impact
Payroll Deduction
$Type amount here per pay period.
Weekly (52)Bi-Weekly (26)Semi-Monthly (24)Monthly (12)Other
Direct Donation

Cash, Check, Credit Card
Cash or Check
Amount enclosed: $Type amount here
Checks made payable to United Way of Greater Niagara
Credit Card
Total Gift: $Type amount here
Visit uwgn.org or call 731-4580 to make a credit card payment
Send Me an Invoice:
One-Time: $Type amount here
Quarterly: $Type amount here
Total Gift: $
Signature
Date

MonthDayYear
Date
Thank you for your gift!
6420 Inducon Drive West, Suite B2 | Sanborn, NY 14132 | 716 -731-4580 | www.uwgn.org
Gift designation is offered as an optional service. The most effective way to help the community is by making an unrestricted gift to United Way.
Designate my gift to another United Way or 501c3 organization
Amount: $
Agency Name:
Agency Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please do NOT provide my name and contact information to the designated agency for acknowledgment of my gift.
Should be Empty:

My Information