2025-2026 Victoria County Pledge Form
Name
*
First Name
Last Name
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Employee ID:
Payroll Deduction - I authorize my employer to deduct the following:
"From the Heart" $1 per pay period
Fair Share option 1 - 1 hour of pay per month
Fair Share option 2 - 1 hour of pay per pay period
$50 per month
$50 per pay period
$30 per month
$30 per pay period
$20 per month
$20 per pay period
$15 per month
$15 per pay period
$10 per month
$10 per pay period
$5 per month
$5 per pay period
$1 per month
One-time donation - cash or check or online
Cash
Check
Online
*checks should be made payable to United Way of the Crossroads. Please submit cash or check donations to your employer's campaign contact; proceed with online donation below. Don't forget to submit this form so your donation counts toward your employer's total giving!
If giving online, click
HERE
or scan this code
How do you want to see your donation invested?
I wish for my donation to be used where it is needed most.
I wish to direct my donation to a specific partner agency.
Please open to view current United Way partner agencies.
Type partner agency name
*if designating your gift.
My total gift is:
*
Multiply by 12 if giving monthly; by the number of pay periods if giving per pay period.
Signature
Let's stay in touch! (select all that apply)
I want to receive email updates about the United Way's work in my community.
I want to be added to the volunteer list and consent to email communications about opportunities.
Please select if you wish to keep your donation anonymous:
do not list my name
Submit
Should be Empty: