Organization Name GIVE DIRECTLY TO UNITED WAY COMMUNITY INVESTMENT PLEASE SELECT YOUR METHOD OF INVESTING UNITED WAY LEADERSHIP GIVING MR/MRS/MS/DR FIRST NAME MI LAST NAME STATE ZIP HOME ADDRESS (For credit card charges and bill me options, your billing address is required.) CITY COMPANY NAME EMPLOYEE ID NUMBER DAYTIME PHONE HOME PHONE White Copy - United Way Yellow Copy - Company Pink Copy - Employee I have been a loyal contributor to the United Way Campaign since . (yyyy) My leadership gift or combined household gift of $1,000 or more qualifies me for membership in the Constitution Society. Spouse/Partner gift amount: Spouse/Partner name: Employer: Please list my/our name(s) as follows: I/We prefer our leadership gift to remain anonymous. FRID ID # _________________ (for Campaign use only) 0815-50K SUPPORT ALL FOUR UNITED WAY COMMUNITY INVESTMENT PRIORITY AREAS THANK YOU FOR LIVING UNITED! 2 4 5 1 PERSONAL E-MAIL ADDRESS UNITED WAY CAMPAIGN 30 Laurel Street Hartford, CT 06106 860-493-6800 EDUCATION Support local children to be successful academically and in life. FINANCIAL SECURITY Support local families to become financially secure. BASIC NEEDS Ensure everyone has access to immediate emergency assistance, such as food and shelter. UNITED WAY MEMBERSHIP OPPORTUNITIES Organization address and phone number. Please see reverse for more details.* I would like to JOIN/RENEW the following membership(s): Neighborhood Arts and Heritage — Diversity through arts and culture programs in Greater Hartford. Please check here if you want to be acknowledged by the organization to which you have directed a gift. MOBILE PHONE PREFERRED FORM OF CONTACT Facebook.com/unitedwayinc @unitedwayinc Direct your contribution to another organization. Or focus your gift on one or more of the following priority areas: COMPANY LOCATION JOIN THE CONVERSATION: unitedwayinc.org 3 OPTIONAL DIRECTED GIFTS *See reverse side for details. United Way Women’s Leadership Council An additional gift of $250, $500 or $1000 qualifies you for membership. Contributions support the Council’s work in financial security and education. United Way Emerging Leaders Society A contribution of $50 or more to United Way Community Investment qualifies you for membership. Contributions support the Society’s work in education. I want my contribution to benefit all United Way partners with the exception of: HEALTH Improving lives of people affected by disability or chronic disease. TOTAL GIFT $ CREDIT CARD BILL ME o One time $ ______________ processed upon receipt by United Way o Monthly $ ______________ per month (starting March 2016) o Quarterly $ ______________ per quarter (starting March 2016) o VISA o MC o AMEX o Discover CREDIT CARD NUMBER EXP. DATE NAME ON CARD PHONE # PAYROLL DEDUCTION I WILL CONTRIBUTE $ PER PAY PERIOD I receive my paycheck: o Weekly (52/year) o Every Two Weeks o Semi-Monthly (24/year) o Monthly I authorize my employer to deduct my total annual contribution from my paycheck in equal amounts. CHECK CASH Enclosed is my check payable to the United Way Campaign. $ TOTAL CHECK # o SECURITIES Please call United Way to transfer funds at 860-493-6800. HOME ADDRESS REQUIRED FOR THESE PAYMENT OPTIONS AMOUNT $ AMOUNT $ AMOUNT $ AMOUNT $ AMOUNT $ AMOUNT $ AMOUNT $ AMOUNT $