2025 Pledge Template

E-PLEDGE OPTIONS

Payroll Deduction

Credit Card/ACH

WORKPLACE PLEDGE CARD FOR TEST COMPANY

United Way values your privacy. For details, please see our Privacy Policy.

Required Employee Information

Please enter your legal name for workplace verification purposes.

First

Middle

Last

Suffix

Work Email Address

Please Confirm your Work Email Address

Employee ID #

Optional Details

I wish to remain anonymous.

This is a joint gift with my spouse/partner.

Please tell us what name(s) you would like us to recognize this gift under.

Please select if you like to receive a thank-you letter and tax receipt for your records.

Preferred Email for Future Correspondence

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

I am a legacy donor and have been donating to ANY United Way for 10 or more years!

Date of Birth

I'm Retiring (Month/Year)

Month/Year

Would you like to be contacted about volunteer committees with United Way? If so, please let us know which position interests you:

Community Impact Committee

Events Committee

Finance Committee

Resource Development Committee

If you would like more information on how your donation is being put to use, please click here to view a list of our current Funded Partner Agencies!

Donation Amount to Be Deducted from Each Pay Period

Your Companies # of Pay Periods per Year:

1 (One-Time Donation) -- Select this option to make a one-time payroll deduction donation.

12 (Monthly) -- Select this option to make 1 payroll deduction donation per month.

24 (Bi-Monthly) -- Select this option to make 1 payroll deduction donation per pay-period.

26 (Bi-Weekly) -- Select this option to make 1 payroll deduction donation per pay-period.

52 (Weekly) -- Select this option to make 1 payroll deduction donation per week.

Investment Amount Per Pay Period

Total Annual Contribution Amount

TOTAL DONATION: $ 0

Please double-check that the $ amount above is the total you want to give to this year’s campaign. Thank you for your support!

Where Your Gift Goes

Please familiarize yourself with our Designation Policy before making any selections.

Invest my donation where it is needed most

Community Impact Fund

The most powerful way to invest your donation. Local volunteers and staff study community contitions and meet with agencies applying for funding to ensure locally informed decisions are made.

Impact Focus Area

Youth Opportunity Fund

Increase access and engagement in education to under-served, at-risk children, teens, and young adults

Financial Security Fund

Stabilize and grow local communities and ALICE households

Healthy Community Fund

Ensure access to healthcare services and healthy choices

Community Resiliency Fund

Increase access to essential resources to individuals and families in crisis

Restricted Contribution

Restrict a portion of my gift

to a local 501(c)(3) human service organization or another United Way. The minimum designation is $100. For more information. please review the designation policy.

Amount per Year to the Community Impact Fund

Amount per Year to the Youth Opportunity Fund

Amount per Year to the Financial Security Fund

Amount per Year to the Community Resiliency Fund

Amount per Year to the Healthy Community Fund

Amount per Year to Another 501(c)(3)

501c3 Organization (Other United Way or Agency)

Name of Organization

Federal Tax ID#

Street Address

City

State

Zip Code

Organization Phone Number

Agreement

My signature below, confirms my pledge as stated above.

Signature

Sign above