UNITED WAY

OF GREATER NIAGARA

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May 2012

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Online Pledge Form

Thank you for making an online pledge to United Way.

Please be assured that your name and address will not be shared to outside organizations unless you authorize United Way to release your information.

* required information

Donor Information

First Name: *

Last Name: *

Spouse:

Address Line 1:

Address Line 2:

Address type:

Business
Home

City:

State:

ZIP/Postal Code:

Email:*

Email Type: *

Business
Home

Phone:*

Phone Type: *

Business
Home
Cell

Alternate Phone

Alt. Phone Type:

Business
Home
Cell

Fax:

Company Name:

Job Title:

Please contact me at:

Home
Work

Billing Information

My total gift amount is:

Please choose one:

I will make a one-time payment.
I would like to be billed monthly, in 3 equal payments.
I would like to be billed monthly, in 12 equal payments.

Payment Method:

Credit Card - We will phone you for your number so as to maintain security.
Check - We will mail you a bill.

Directing Your Gift (Optional)

The Community Care Fund

The Community Fund is directed by experienced local volunteers who determine our area's most urgent needs and select agencies with proven impact. They make sure that the Community Fund makes your caring count.

I'd like to support the Community Care Fund:

Please direct all of my gift to the Community Fund.
Please direct part of my gift to the Community Fund.

:: :: Enter the percentage here:

:: :: Please exclude the following organization(s) from my gift:

Specific Agency

Please direct my gift to the following United Way or agency.

Agency Name

Enter percentage here:

Agency Name

Enter percentage here:

Agency Name

Enter percentage here: