2025/2026 Payroll Deduction

MY INFORMATION

Title

First

Last

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Cell Phone Number

Work Phone Number

My Employer:

Date of Birth

How many years have you been a United Way donor?

MY INVESTMENT

Check all that apply:

I am retiring this year, please keep in touch

I am interested in volunteer opportunities

I want to contribute the following amount per pay period:

$38.50*

Your gift of $38.50 per bi-weekly pay period qualifies you in a Giving Community.

$25

$15

Other…

I am paid:

Weekly (52)

Bi-Weekly (26)

Bi-Monthly (24)

Other…

My annual gift:

MY IMPACT

I want to give to:

he most efficient and effective way to invest in United Way’s work in the areas of healthy community, youth opportunity, financial security, and community resiliency.

You can choose to designate your gift of $104 or greater to one specific organization. It must be tax-exempt 501(c)(3), not fraternal, political, or religious in nature. They may use these funds at their discretion.

Enter the name of the organization you'd like to designate your gift to:

*Your gift of $1,000 or more per year ($38.50 per week) qualifies you for membership in a United Way giving community. As a member, you will receive invitations to special events, exclusive volunteer opportunities, and listing in our annual report.

Navigator Society - Supports community impact initiatives

Women United - Supports early childhood development and literacy initiatives

OPTIONAL: My contribution is part of a household gift. Please combine my pledge with:

Please list name and company affiliation.

I / We would like to be acknowledged as:

By checking this box, I pledge to make the gift above through payroll deductions at my company.

I want to join the fight for health, education, financial stability, and basic needs in my community.

Solid Red