Please do not mail this envelope. Call (860) 493-6800 for pick-up. Community Campaign Use Only: Company ID #
Envelope #
Initials
United Way Community Campaign
Partial Report Full Report Retiree Report eWay Report
Report Envelope CAMPAIGN YEAR:
Organization Name Street Address City
# of Employees in organization:
State
# of donors giving $1,000 or more in this envelope:
Zip
STEP 1: GIFT INFORMATION CONTRIBUTIONS/PLEDGES
# OF GIVERS
TOTAL AMOUNT
AMOUNT ENCLOSED
Payroll Deductions
(Employer retains signed yellow forms. Please enclose white forms) *
OTHER PLEDGE METHODS: Check / Cash
(Please enclose white forms and checks payable to United Way Community Campaign.)*
Credit Card
(Please enclose signed white forms with addresses) *
To be billed by United Way
(Please enclose signed white forms with addresses) *
Stock
(Please enclose signed white forms with addresses) *
SUBTOTAL Corporate Pledge GRAND TOTAL FOR ENVELOPE * Please use Special Event Report Envelope for event funds.*
STEP 2: CAMPAIGN COORDINATOR INFORMATION Name Date
Signature Phone
STEP 3: BILLING INFORMATION, IF APPLICABLE Billing Address
Phone
Contact for company billing questions
(Community Campaign use only)
Donor Relations: Staff/LE Name: __________________________________________ Date: __________________________________________________ United eWay Campaign use only: Uploaded By/Date________________________________________ Special Gifts
Finance Department: Deposit Date: _________ Credit Date: _________ Deposit ID#: _________ Audited By: _______________________________ Date: _______________ Processed By: _____________________________ Date: _______________ Date Posted: ___________________________________________________ Batch Control Number
THANK YOU! United Way Community Campaign • 30 Laurel Street • Hartford, CT 06106-1374 • (860) 493-6800 • FAX (860) 493-6859 • unitedwayinc.org
ATTENTION: Company Coordinator Please complete the face of the envelope, seal it, and sign across the flap.
Thank you for your cooperation!
For Community Campaign use only: Adjusted To /From
Envelope #
Date
Description/Comments:
Notes:
0512-2K