United Way of the CSRA Pledge Form Tell Us About Yourself ---Mr.Mrs.Ms.Dr. I wish for my gift to remain anonymous ---Yes I have been a loyal contributor since Payment Options Easy Payroll Deduction Amount per pay period ---$5$10$15$20 Other $ Stocks/Securities Yes Please call 706-922-8927 to facilitate the transaction or visit uwcsra.org/donate for more info. Credit Card Payment Make a one-time or monthly recurring gift securely online by visiting www.uwcsra.org I've already paid online ---YesNoDate Amount Paid Online Payment Enclosed Cash ---YesNo Check (payable to United Way of the CSRA) ---YesNo Bill Me (A home address and a minimum donation of $25 is required.) When ---OnceMonthlyQuarterlyTwice a yearStarting in Donor Designation Policy United Way of the CSRA does not encourage designations, however, we will process designations to 501(c)(3) health and human service agencies as a service to our donors. The designation must be $150 or greater in order to be processed. After an effort to contact the donor, any designations that are below $150 and do not qualify as a 501(c)(3) health and human service agency or is no longer operational will be directed to United Way’s Community Wide Initiative. An admin fee will also be deducted. Total Contribution (Payroll deductions typically begin January 1st) My total contribution for the year: (required to process pledge) This is a joint contribution Yes Thank you for your contribution! Would you like a copy of this form? Yes Join and Affinity Group Each group offers special events, volunteer opportunities, and custom messages for members about the results of your investment in United Way. Caring Club Yes Join with an annual investment of $150+ $12.50 a month or more undesignated Receive exclusive discounts and offers across the CSRA from food to entertainment to haircuts and more by being a Caring Club Member. For full program details visit www.uwcsra.org. Focus 45 Yes Join with an annual investment of $180+ $15.00 a month or more F45 membership is for our young leaders age 45 and younger who are looking to connect with each other through community events and make an impact on their own terms through United Way. Leadership Circle Yes Join with an annual investment of $500+ Join an elite group of givers who recognize the needs of our community and are committed to creating lasting change while discovering their impact through United Way. More Info Please provide me with info on: How I can include United Way in my will to leave a lasting legacy Yes Volunteer opportunities in the community Yes Citizens Review Panel Volunteering (See firsthand how your dollars impact our community.) Yes Thank you for your contribution to United Way of the CSRA. No goods or services were provide in exchange for this contribution. Please keep a copy of this for your tax records. If you made a contribution via payroll deduction, you will also need a copy of your pay stub, W-2 or other employer document showing this amount withheld and paid to a charitable organization. We do not send tax receipts for payroll contributions. Consult your tax advisor for more information. Δ
