1 Start 2 Complete Preferred Donation Method Options - Select One - None -Payroll DeductionCheckCashCredit Card or ACHDirect Bill Total Annual Gift to be billed: Total Annual Gift: Frequency you are Paid - None -Weekly (52 times/yr)Bi-Weekly (26 times/yr)Semi-Monthly (24 times/yr)Other If other, what frequency: I authorize my employer to deduct the folloiwng amount from my paycheck: $ Amount of Check Amount of Cash If donating by credit card or ACH, please CLICK HERE to exit this form and complete your online transaction. Please bill me: Monthly Quarterly One-Time My Contact Information First Name * Last Name * Home Address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Employer Name * Email Address * Office Phone * Cell Phone Leadership Giving United Way encourages leadership giving. A gift of $500 or MORE qualifies for membership in the Capital Club Leadership Giving Society. We will recognize your individual or combined leadership gift. Please indicate how your name(s) appear in publication: Yes, I/We wish to remain anonymous. Do not release my/our name. No, I/We do not wish to remain anonymous. I/We wish to remain anonymous. Do not realease my/our name. Name(s) Is your donation to be combined with a spouse or partner? Yes No Company Affiliation(s) Name workplace Gift Amount Donor Notes Donor Notes Signature * Please check the accuracy of all your entries and make a copy for your tax records. United Way does not provide goods or services as whole or partial consideration for any contribution. Donor does not expect to receive any financial or economic benefit as a result of this contribution. West Virginia resident may obtain a summary of the contribution and financial documents from the Secretary of State, State Capitol, Charleston, WV 25305. Contribution does not imply endorsement. Submit
