Please do not mail this envelope. Call (860) 493-6800 for pick-up. For United Way Staff Use Only:
Company ID #
Envelope #
Initials
UNITED WAY COMMUNITY CAMPAIGN
Partial Report Full Report Retiree Report eWay Report
REPORT ENVELOPE COMMUNITY CAMPAIGN YEAR:
Organization Name: Street Address: City:
# of employees in organization:
State:
STEP 1: GIFT INFORMATION
# of contributors giving $1,000 or more in this envelope:
Zip:
* Please use Special Event Report Envelope for United Way 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 staff use only.)
SUBTOTAL Corporate Pledge GRAND TOTAL FOR ENVELOPE
STEP 2: WORKPLACE COMMUNITY CAMPAIGN COORDINATOR INFORMATION Name:
Signature:
Date:
Phone:
Email:
STEP 3: BILLING INFORMATION, IF APPLICABLE Billing Address:
Phone:
Contact for company billing questions:
Email:
(For United Way Staff Use Only)
UW Staff Name: _________________________________________ Date: __________________________________________________ For Electronic Community 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:
THANKS! United Way Community Campaign • 30 Laurel Street • Hartford, CT 06106-1374 • (860) 493-6800 • FAX (860) 493-6859 • unitedwayinc.org
ATTENTION: Workplace Community Campaign Coordinator
Please complete the face of the envelope, then seal and sign it across the flap.
Together, we’ll find the best way to build a stronger community and help our hard-working families.
Notes:
0817-1500