My Informaon. PLEASE PRINT CLEARLY AND PRESS FIRMLY. Your personal informaon is kept confidenal and will never be sold or shared. 2 My Giſt. Please consider 1 hour’s pay per month, 1% of your annual income, or an increase over last year’s giſt. THANK YOU! WHITE: Payroll YELLOW: United Way PINK: Donor Signature_________________________________Date_____________ I would like my giſt to remain anonymous. Mr. Mrs. Ms. Dr. 1 Oponal Please direct my contribuon to another non-profit 501(c)(3) organizaon ($50 minimum contribuon required). AMOUNT $ ORGANIZATION NAME AND LOCATION No goods or services were provided in exchange for this contribuon. Please keep a copy of this form for your tax records. You will also need a copy of your pay stub, W-2 or other employer document showing the amount withheld and paid to a charitable organizaon. Contact your tax advisor for more informaon. Name _______ First Middle Inial Last Date of Birth Home Address _______________________________________________________________ _______ City State Zip Employer ______________________________________________________________Union Affiliaon (if any) Work Phone _______ Personal Email _______________________________________________________________ Home Phone ________________ GREAT THINGS HAPPEN WHEN WE LIVE UNITED! PLEDGE FORM Lake Area United Way 221 W. Ridge Road Griffith, IN 46319 219-923-2302 x 306 [email protected] www.lauw.org JOIN THE VANGUARD! An annual individual contribuon, or a combined family contribuon, of $1,000 or more qualifies you for recognion as a Vanguard Member, including free Vanguard events year-round. Please combine my giſt with my spouse/partner’s giſt to Lake Area United Way. Their name _________________________________________________________ Their employer_______________________________________________________ Please list my/our name(s) as follows: ___________________________________________________________________ FAST TRACK to the Vanguard with a pledge to reach the $1,000 level in 3 years. Contact me about joining the VANGUARD. VOLUNTEER! (We’ll contact you with more informaon). I am interested in ‘United We Read’, which helps area elementary students become successful readers. I am interested in other volunteering opportunies. MAKE EVEN MORE GREAT THINGS HAPPEN! BILL ME $50 minimum and home address required I have been a United Way donor for 10 years or more. (This applies to donaons made to any United Way.) I will be rering on ________________. Aſter this date, please contact me to inform me of giving & volunteering opons. $ Total Annual Giſt: We’ll email you a link so you can make a giſt securely on our website. $ Total Annual Giſt: CREDIT CARD or AUTOMATIC BANK WITHDRAWAL Email address (required): PAYROLL DEDUCTION Amount per pay period: $ Number of pay periods per year: $ Total Annual Payroll Deducon: Monthly X 12 $ Quarterly X 4 $ GIFT IS ATTACHED Cash Check (make payable to Lake Area United Way) Check # $ Total Payment Enclosed: One Time $ 3 My Authorizaon. I authorize Lake Area United Way and/or my employer to process my pledge as directed above.