2026 United Way Campaign
Employee Campaign Coordinator
Company Name
*
CEO/Manager
*
First Name
Last Name
CEO/Manager Signature
*
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Coordinator Name
First Name
Last Name
Coordinator Email
example@example.com
Coordinator Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Does your company offer payroll deduction?
*
Please Select
Yes
No
How many promotional materials do you need?
Submit Form
Submit Form
Should be Empty: