Workplace Pledge Card - UWCIL Your Information Your Name Title First Middle Last Suffix Birthday Your Contact Information Company Email Phone Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Code Donation Method Preferred Donation Method Payroll Deduction Check Cash Credit Card Payroll Deduction Contribution Amount Per Pay Period $5 $10 $20 $25 $50 Other… Please enter the NUMBER only $ Number of Pay Periods for Donation One Time 26 pay periods (bi-weekly) Other… Please enter the NUMBER of pay periods for this donation Check Donation Amount of Check $ Make checks payable to United Way of Central Illinois. Please give the check to your Campaign Coordinator within 24 hours of this pledge. Cash Donation Amount of Cash $ Please give your cash donation to your Campaign Coordinator within 24 hours of this pledge. Credit Card Donation After completing this form you will be redirected to our payment page where you will be able to complete your donation details and process your transaction in a secured environment. Thank you! Total Annual Contribution TOTAL: $0 Update Donation Details Designation Options United Way Community Impact Fund - Invest my donation in the Community Fund where it will have the greatest impact Education Basic Needs Health Financial Stability Specific Charity or United Way program Name of Charity or United Way Program: United Way processes donor-directed contributions as a service to our donors. United Way if unable to guarantee how funds will be used or ensure measurable results by the recipient agency • If the designation agency is not easily identified by the information provided, is not a registered 501(c)(3), does not certify as Patriot Act compliant, is no longer in operation, and/or does not cash any checks within one year, your gift will go to where it is needed most in our local community. • If less than 100% of your total gift above is selected, the balance will be invested in United Way programs. If dividing your donation between multiple designation options, please indicate below how you wish to divide your gift: Check here if you wish to remain anonymous Agreement My signature below, confirms my pledge as stated above. Signature Reset CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Proceed to Payment Page Submit
