All nonprofits receive 100% of contributions directed to them. } My gift total for the year is $ ________ Gifts to Community Shares of Wisconsin and its member nonprofits are tax deductible as allowed by law. Name Date Employer Home Address City State Zip Home Email YOUR SUPPORT I pledge my support to Community Shares of Wisconsin as follows: m I authorize my employer to deduct the amount of $ _______ each pay period in 2016 for _____ pay period(s) until my pledge of $ ________ is paid in full. Authorization signature: m I have enclosed a check/cash gift in the amount of $ _________ (Make checks payable to Community Shares of Wisconsin.) m I am charging my gift in the amount of $ __________ m VISA m MASTERCARD m DISCOVER m AMERICAN EXPRESS Card # Expiration date Signature Date m Please bill me in the amount of $ ________. q Before year end 2015 q In January 2016 m I would like to give a gift of stock, please send details. m Please send me information about making a planned gift. YOUR CHOICE A gift to Community Shares supports ALL groups: $ ________. And/Or I direct a total of $ _________ to the groups as indicated below. $ ________ 1000 Friends of Wisconsin $ ________ ABC for Health $ ________ ACLU of Wisconsin Foundation $ ________ Arts Wisconsin $ ________ Bayview Foundation $ ________ Center for Media and Democracy $ ________ Center for Resilient Cities $ ________ Chrysalis $ ________ Citizens for Safe Water Around Badger $ ________ Citizens Utility Board $ ________ Clean Wisconsin $ ________ Coalition of Wisconsin Aging Groups $ ________ Common Wealth $ ________ Community GroundWorks $ ________ Dane County TimeBank $ ________ Disability Rights Wisconsin $ ________ End Domestic Abuse Wisconsin $ ________ Fair Housing Center of Greater Madison $ ________ Fair Wisconsin Education Fund $ ________ Freedom Inc. $ ________ Friends of Wisconsin State Parks $ ________ Gathering Waters: Wisconsin’s Alliance for Land Trusts $ ________ Grassroots Empowerment Project $ ________ GSAFE $ ________ Housing Initiatives $ ________ Interfaith Coalition for Worker Justice $ ________ League of Women Voters of Wisconsin $ ________ Legal Action of Wisconsin $ ________ Linda and Gene Farley Center for Peace, Justice, and Sustainability $ ________ Madison Area Community Land Trust $ ________ Madison Audubon Society $ ________ Midwest Environmental Advocates $ ________ NARAL Pro-Choice Wisconsin Foundation $ ________ New Harvest Foundation $ ________ Nuestro Mundo Inc. $ ________ OutReach $ ________ Perfect Harmony Men’s Chorus $ ________ Physicians for Social Responsibility—Wisconsin $ ________ The Progressive $ ________ Project Home $ ________ Rape Crisis Center $ ________ REAP Food Group $ ________ River Alliance of Wisconsin $ ________ Rock River Coalition $ ________ Sierra Club Foundation-John Muir Chapter $ ________ Sustain Dane $ ________ Tenant Resource Center $ ________ UNIDOS Against Domestic Violence $ ________ Wisconsin Alliance for Women’s Health $ ________ Wisconsin Coalition Against Sexual Assault $ ________ Wisconsin Council of the Blind and Visually Impaired $ ________ Wisconsin Council on Children and Families $ ________ Wisconsin Democracy Campaign $ ________ Wisconsin Early Childhood Association $ ________ Wisconsin Family Ties $ ________ Wisconsin Farmer’s Union $ ________ Wisconsin League of Conservation Voters Institute $ ________ Wisconsin Literacy $ ________ Wisconsin Network for Peace and Justice $ ________ Wisconsin Wetlands Association $ ________ Wisconsin Women’s Network $ ________ Women In Transition $ ________ Working Capital for Community Needs $ ________ WORT 89.9 FM Community Radio Neither Community Shares nor its member nonprofits provide goods or services to the donor in return for contributions. Please note: Taxpayers who want to deduct charitable contributions must maintain a record of all gifts in the form of a bank record, canceled check, or a receipt. If you choose payroll contribution, keep for your records copies of a pay stub, W-2 form, or other document from your employer that indicates the amount withheld for charity during the tax year. If you don’t receive an acknowledgement/thank you within a month of submitting your pledge form, please contact us at [email protected]. Thank you! WHITE COPY: COMMUNITY SHARES OF WISCONSIN YELLOW COPY: PAYROLL OFFICE PINK COPY: EMPLOYEE OF WISCONSIN 612 West Main Street, Suite 200 • Madison, WI 53703 608.256.1066 • www.communityshares.com PLEDGE FORM Please print information as you would like it to appear in our records.