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