2016 UNITED WAY CAMPAIGN 30 Laurel Street, Hartford, CT 06106 | 860-493-6800 | UnitedWayInc.Org Please complete and return to your company or mail to the address above.
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MR/MRS/MS/DR FIRST NAME
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MI L AST NAME
HOME PHONE
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HOME ADDRESS (For credit card charges and bill me options, your billing address is required.) CITY/STATE/ZIP COMPANY
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COMPANY LOCATION
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WORK EMAIL
DAYTIME PHONE MOBILE PHONE
EMPLOYEE ID NUMBER
PREFERRED FORM OF CONTACT
PERSONAL EMAIL
I CHOOSE TO IMPROVE LIVES IN THIS WAY: n Make the biggest impact locally and support all four United Way Community Investment priority areas . . . . . . . . . . AMOUNT $ Please see reverse for more details.
Or I choose to target my gift to one or more of the following priority areas: n EDUCATION Support local children and youth to be successful academically and in life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . AMOUNT $ n FINANCIAL SECURITY Support local families to become financially secure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AMOUNT $ n BASIC NEEDS Ensure access to immediate emergency assistance, such as food and shelter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . AMOUNT $ n HEALTH Providing access to healthcare services, prevention, treatment and research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AMOUNT $ I want my contribution to benefit all United Way partners with the exception of
United Way Membership Opportunities I would like to JOIN/RENEW the following membership(s):
n UNITED WAY WOMEN’S LEADERSHIP COUNCIL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AMOUNT $
An additional gift of $250, $500 or $1000 qualifies you for membership. Contributions support the Council’s work in financial security and education.
n UNITED WAY EMERGING LEADERS SOCIETY
A gift of $50 or more to United Way Community Investment above qualifies you for membership. Contributions support the Society’s work in education. Optional Directed Gifts Please see reverse for more details. n Neighborhood Arts and Heritage Diversity through arts and culture programs in Greater Hartford. . . . . . . . . . . . . . . . . . . . . . . . . . . . . AMOUNT $ n Direct your gift to another qualified not-for-profit organization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AMOUNT $ Organization name, address, phone number. Please see reverse for more details.
n Please check here if you want to be acknowledged by the organization to which you have directed a gift. Please consider an additional gift of $25 in honor of the 25th anniversary of United Way Year of Caring. Please see reverse for more details. . . . . . AMOUNT $
Thank you for LIVING UNITED. Please add all columns to total your gift.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTAL GIFT $
METHOD OF GIVING n PAYROLL DEDUCTION
I authorize my employer to deduct my total annual gift from my paycheck in equal amounts. I will contribute $___________ per pay period. I receive my paycheck: n Weekly (52/year) n Every Two Weeks (26/year) n Semi-Monthly (24/year) n Monthly
n CREDIT CARD
n BILL ME BY EMAIL Home address & email required above n One time $ __________ processed upon receipt by United Way n Monthly $ __________ per month (starting March 2017) n Quarterly $ __________ per quarter (starting March 2017) n VISA
n MC
n BILL ME
n AMEX
NAME ON CARD
Enclosed is my check payable to the United Way Campaign. TOTAL $_____________________ CHECK #____________________
n Discover
CREDIT CARD NUMBER
n CHECK OR n CASH
EXP DATE
SECURITIES: Please call United Way to transfer funds at 860-493-6800.
PHONE
UNITED WAY LEADERSHIP INVESTORS My leadership gift or combined household gift of $1,000 or more qualifies me as a Leadership Investor. Spouse/Partner gift amount: $________________ Spouse/Partner name:_________________________________________________________ Employer:________________________________________________________________ Please list my/our name(s) as follows: _____________________________________________ n I/We prefer our leadership gift to remain anonymous. I have been a loyal contributor to the United Way Campaign since (yyyy):_____________________
YOUR SIGNATURE YOUR SIGNATURE IS REQUIRED FOR PAYMENT BY CREDIT CARD For Campaign use only
White Copy: United Way Yellow Copy: Company Pink Copy: Employee
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DATE 0716/40K
Thank You for Giving and Creating a Community of Possibilities. United Way’s mission is to engage and bring together people and resources committed to the well-being of children and families in our community. When you give to United Way Community Investment, you support partnerships and programs that help children and families in central and northeastern Connecticut succeed.
Help children and youth succeed academically and in life Early childhood education After school and summer learning opportunities
Ensure families become more financially secure Training and employment services Financial coaching
Provide access to basic needs United Way 2-1-1 information and referral services Access to immediate emergency assistance, such as food and shelter
Support healthier lives Access to health-related services Access to prevention, treatment and research through Community Health Charities
INFORMATION ABOUT YOUR GIFT Please keep a copy of this form for your tax records. You will also need a copy of your paystub, W-2 or other employer document showing the amount withheld and paid to a charitable organization. Consult your tax advisor for more information. Undesignated campaign pledges will be distributed through United Way and Community Health Charities as agreed upon by both organizations. Optional Directed Gifts United Way of Central and Northeastern Connecticut is honored to partner with your employer in helping employees give back to issues they care about. If you direct a portion or all of your gift to any qualified not-for-profit organization recognized as a 501(c)(3) by the Internal Revenue Service, the organization’s name, address and phone number is required. If we cannot locate your directed organization, or if it is not an IRS qualified 501(c)(3) organization that is Patriot Act Compliant, we will make every reasonable attempt to contact you. If we cannot contact you, your gift will go toward United Way Community Investment in your local area. Please note that such restricted gifts are not monitored by United Way of Central and Northeastern Connecticut or Community Health Charities. How Your Contributions Are Distributed Contributions directed to organizations through United Way are subject to a 10 percent fee (includes administration and fundraising costs), capped at $100 per directed gift (assessed on a pro-rata basis upon gift proceeds received). No fees are deducted by United Way from contributions to Community Health Charities, or any Community Health Charities Federation or their member charities. Community Health Charities deducts its own administrative fee prior to disbursement of these gifts. Payroll deduction contributions will be distributed directly to designated organizations in April, July, October, and December 2017, and March and June 2018, if proceeds and pledge details are received by United Way on or before the end of the month preceding payout. Check, credit card or stock payments will be distributed to directed organizations by February 28, 2017, if proceeds and pledge details are received by United Way on or before December 31, 2016.
Celebrating 25 Years of Mobilizing Workplace Volunteers to Improve Community Conditions. Interested in participating in Year of Caring? Visit UnitedWayInc.Org/YearOfCaring
Thank You for Your Gift! No goods or services were provided in exchange for this contribution.
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