MCC Campaign Form

Name

First NameLast Name

Email

Your personal information is kept confidential. Mesa United Way uses this information to acknowledge your gift, provide necessary tax receipts, and communicate how your gift is helping the community.

Employee ID

Please enter your company ID number.

Amount per Paycheck:

Total Annual Pledge:

Amount per paycheck x 24 pay periods

Optional Gift Designations (Undesignated gifts will support Mesa Unites Fund. Designations total should not exceed annual gift.)

Any other information you need to communicate? (optional)

THANK YOU FOR YOUR DONATION, {name}!

Signature

Your contribution is tax deductible to the extent allowed by law. No goods or services were provided in exchange for this contribution.