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
special event report Envelope CAMPAIGN YEAR: Organization Name Street Address City
State
Zip
STEP 1: SPECIAL EVENT INFORMATION NAME OF EVENT
TOTAL AMOUNT
AMOUNT ENCLOSED
GRAND TOTAL FOR ENVELOPE * Please use Report Envelope for funds not related to special events.*
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________________________________________
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!
0512-800