Please do not mail this envelope. Call (860) 493-6800 for pick-up. Company ID #
For Campaign Use Only:
Envelope #
Initials
UNITED WAY CAMPAIGN
Partial Report Full Report Retiree Report eWay Report
REPORT ENVELOPE CAMPAIGN YEAR:
Organization Name Street Address City
# of employees in organization:
State
# of contributors giving $1,000 or more in this envelope:
Zip
STEP 1: GIFT INFORMATION
* Please use Special Event Report Envelope for event funds.*
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 Campaign.)*
Credit Card
(Please enclose signed white forms with addresses)*
Billed by United Way
(Please enclose signed white forms with addresses)*
Stock
(Please enclose signed white forms with addresses)*
Memo Bypass
(For United Way use only)
SUBTOTAL Corporate Pledge GRAND TOTAL FOR ENVELOPE
STEP 2: CAMPAIGN COORDINATOR INFORMATION Name
Signature
Date
Phone
STEP 3: BILLING INFORMATION, IF APPLICABLE Billing Address
Phone
Contact for company billing questions
(Campaign Use Only)
Donor Relations: Staff/LE Name: __________________________________________ Date: __________________________________________________ United eWay Campaign Use Only: Uploaded By/Date________________________________________ Special Gifts
Third Party
Donor Services: Credit Date: _________ Deposit Date: _________ Deposit ID#: _________ Audited By: _______________________________ Date: _______________ Processed By: _____________________________ Date: _______________ Date Posted: ___________________________________________________ Batch Control Number
THANK YOU! United Way 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 dedication to improve lives for children and families in our community!
For United Way Campaign use only: Adjusted To /From
Envelope #
Date
Description/Comments:
Notes:
0514-3K