2025 EMPLOYEE CAMPAIGNS Pledge Form

2025 Employee Campaign Pledge Form

UNITED WAY OF FRANKLIN COUNTY - Learn more about the organization at www.uwfcpa.org
Name*

First NameLast Name
Company*
Your Employer*
Your E-mail*
Your Phone Number*

Area CodePhone Number
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date

MonthDayYear
Date
Your Name(s) as you'd like it to appear in published materials.
Include spouse/partner's name if you would like to be recognized together. (ex. John and Jane Doe)
I prefer to remain Anonymous - (If you select yes, your name will not be listed in any donor recognition)

NoYes
I want to be thanked:*

By emailBy mailI prefer not to be thanked
Leadership Giving Levels

Please consider joining at one of the following levels to make a difference in the lives of others through a meaningful financial gift:

Tocqueville Society - $10,000

Chairman's Club - $5,000-$9,999

President's Club - $2,500-$4,999

Vice President's Club - $1,000-$2,499

Director's Club - $500-$999

Emerging Leader (under age 40) - $250+
Select Your Donation Method*
Payroll Deduction

If you selected payroll deduction, please complete this section.
Amount ($) per pay period
Number of Pay Periods
TOTAL PAYROLL DEDUCTION
Amount x Number of Pay Periods = TOTAL
OR
One Time Payroll Deduction of:
Amount ($)
One Time Donation

Note: Minimum donation of $25 for Credit Card payment.
Payment Method
Donation Amount

prevnext( X )
USDDescription
Donation Pledge for Cash or Check
Cash or Check payments can be mailed or dropped off to our office: 182 S. Second Street, Chambersburg, PA 17201.

Checks can be made payable to "United Way of Franklin County"
Bill Me

Note: Minimum of $50 donation for the Bill Me option.
TOTAL Donation Pledge
Note: minimum donation of $50
Billing Schedule

Single (One Time Donation)Semi-AnnualQuarterlyMonthly
United Way will bill you the number of times requested to equal the total pledge given.

Ex: Total Donation Pledge = $200, and request is to be billed quarterly. This means you will be billed for four payments of $50 over the next year.
Your Investment in Community

The "Community Impact Fund" is the most powerful way to invest your contribution. This fund benefits our Program Partners, which are listed at www.uwfcpa.org/program-partners.

You may also choose to direct your donation to benefit programs serving a specific focus area from our Core Values: Early Learning, Financial Stability, Basic Needs, and Healthy Living.

Another option is to invest in the United Way Endowment Fund, which allows your gift to support United Way and our community into the future.

To designate to a specific agency or other United Way, select "Restricted Contribution."

Your Impact
Where would you like to direct your donation?
Restricted Contribution...

If you prefer to designate all or a portion of your donation OUTSIDE UNITED WAY OF FRANKLIN COUNTY & OUR COMMUNITY IMPACT FUND to a specific 501(c)3 or other United Way, please complete the information below.

NOTE: A minimum contribution of $55 is required for your designation to be processed. Restricted contributions are subject to a 13% administrative fee.
Agency's Complete Name
Agency's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Amount ($) to be donated to agency
I am interested in receiving (check all that apply)

Email Updates from UWFCVolunteer OpportunitiesInformation on Planned GivingSponsorship Opportunities for BusinessesOther
Your Signature is Required to Authorize Your Gift/Pledge (use your mouse to draw, or finger if using a touch screen)*

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NOTE: Minimum amount for credit card donation is $25. Please make sure your donation is $25 or above if paying with credit card before clicking submit, otherwise your transaction will not go through.
Once you click submit, please do not close the window or hit refresh. Once the pledge form is submitted, you will be redirected to the United Way of Franklin County website.

An email confirmation will be sent to you.
Once you click the "Submit" button, please do not refresh or exit out of the window until you are redirected to submit your credit card information.

An email confirmation will be sent to you.
Should be Empty:

2025 Employee Campaign Pledge Form

Payroll Deduction

One Time Donation

Bill Me