UWTVA Campaign Pledge Card Hometown Giving...Results you can see
UWTVA Campaign Pledge Card
Hometown Giving...Results you can see
United Way of the Tri-Valley Area
P.O. Box 126, Farmington, ME 04938
(207) 778-5048
1 Your Name ________________________________________Employee ID _________________________
2 Home Address_____________________________ City/State/ZIP ________________________________
Home Phone ___________________ Work Phone___________________ E-mail _____________________
3 Choose one of the following options
· Option One Cash Gift
[ ] I am enclosing my total gift of $________
· Option Two Installment Plan Pledge
[ ] I pledge $ __________ Bill me ($100 min.) [ ] Quarterly (Jan., Apr., July, Oct.)
[ ] Once on (after 12/31/02)_____
· Option Three Credit Card (MC/Visa)
Card Type: VISA_____ M/C_______ Card #________-________-________-________
4 Your Signature___________________________________________Date_________________________
5 Leadership Circle (Please complete if total contributions from you and your spouse are $300 or more.)
May we include your name in our Leadership Circle Member Brochure? [ ] Yes [ ] No
If your contribution should be combined with a spouse please indicate:
Name of Spouse____________________________ Spouses Employer ___________________________
I/We should be listed as follows: __________________________________________________________
6 Donor Choice: If you wish to designate your gift, please complete one of the following options:
[ ] Local United Way Community Fund: Tri-Valley United Ways experienced allocation volunteers monitor agencies
and make sure that your donation helps local people who really need your help. Your gift will help strengthen families, promote self-sufficiency, improve health and provide services for children, senior citizens, and help people with disabilities.
[ ] Please send my gift to the United Way that covers my home town. (Please complete line 2)
[ ] Please send my gift to this United Way participating agency _________________________________________
[ ] Please send my gift to the following agency that is not a participating agency of this United Way.
Agency Name & Address _______________________________________________________________________
Note: The agency designated must a) provide human care services this excludes those of a religious or political nature and b) have certified non-profit charitable status under section 501(c)(3) of the Internal Revenue Code. ($26 minimum).
Please make sure that your pledge card is complete and legible. If designations are illegible or do not meet criteria, United Way will make an attempt to reach you. If we are unable to do so, your gift will be allocated through the Community Fund by local volunteers. United Way of the Tri-Valley Area cannot certify the financial or program viability of agencies whose programs are not reviewed by our volunteers.
No goods or services were provided in consideration for this contribution.
The full amount of your united Way donation qualifies as a tax deduction.
Thank You