UNITED WAY CAMPAIGN
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30 Laurel Street, Hartford, CT 06106 unitedwayinc.org LAST NAME
HOME PHONE
HOME ADDRESS (For credit card charges and bill me options, your billing address is required.)
CITY
STATE
COMPANY NAME
EMPLOYEE ID NUMBER
DAYTIME PHONE
MR/MRS/MS/DR
FIRST NAME
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ZIP
PERSONAL E-MAIL ADDRESS
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THANK YOU FOR INVESTING IN YOUR COMMUNITY. TO SELECT ONE OR MORE INTEREST AREAS, CHECK BELOW. See reverse for an explanation of the interest areas.
AMOUNT $
EDUCATION Helping children enter school ready to learn and succeed academically.
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INCOME Assisting families to become financially secure. HEALTH Providing access to healthcare services.
AMOUNT $
BASIC NEEDS Ensuring everyone has food, shelter and other essential services.
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UNITED WAY COMMUNITY INVESTMENT To support all of the above Community Investment interest areas, check here. United Way Community Investment advances the common good by improving lives and changing community conditions, contributing to a better life for all.
AMOUNT $
— Improving the lives of people affected by disability or chronic disease.
AMOUNT $
NEIGHBORHOOD ARTS AND HERITAGE — Diversity through arts and culture programs in Greater Hartford. DIRECT YOUR CONTRIBUTION TO AN AGENCY OF YOUR CHOICE:
AMOUNT $
AMOUNT $ Agency Name
Agency address and phone number. Please see reverse for more details.* PLEASE CHECK HERE IF YOU WANT TO BE ACKNOWLEDGED BY THE AGENCY YOU HAVE DESIGNATED.
LEADERSHIP GIVING
MEMBERSHIP OPPORTUNITIES
I have been a loyal contributor to the United Way Campaign since
I would like to JOIN/RENEW the following membership:
. (yyyy)
United Way Women’s Leadership Council with an additional gift of:
My leadership gift or combined household gift of $1,000 or more qualifies me for membership
$250
in the Constitution Society. Spouse/Partner gift amount: Spouse/Partner name:
United Way Community Investment.
Please list my/our name(s) as follows: I/We prefer our leadership gift to remain anonymous.
PLEASE SELECT YOUR METHOD OF INVESTING
PAYROLL DEDUCTION
I WILL CONTRIBUTE $
$1,000
United Way Emerging Leaders Society with a contribution of $50 or more to
Employer:
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$500
Contributions support the Council’s Family Financial Stability Initiative.
THANK YOU FOR LIVING UNITED! HOME ADDRESS REQUIRED FOR THESE PAYMENT OPTIONS
CHECK PER PAY PERIOD
TOTAL GIFT $
CREDIT CARD
BILL ME
o One time $ ______________ processed upon receipt by United Way
I receive my paycheck:
Enclosed is my check payable to the United Way Campaign.
o Weekly (52/year)
$ TOTAL
o Quarterly $ ______________ per quarter (starting March 2014)
o Every Two Weeks
CHECK #
o VISA
o Semi-Monthly (24/year)
o SECURITIES
o Monthly
Please call United Way to transfer funds at (860) 493-6800. $ (Approx. value)
I authorize my employer to deduct my total annual contribution from my paycheck in equal amounts.
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SIGNATURE (REQUIRED)
FRID ID # _________________ (for Campaign use only)
o Monthly
$ ______________ per month (starting March 2014) o MC
o AMEX
o Discover
CREDIT CARD NUMBER
EXP. DATE
NAME ON CARD
PHONE #
DATE
White Copy - United Way
Yellow Copy - Company
Pink Copy - Employee
0613-65K