United Way of Lincoln County

WORKPLACE PLEDGE CARD

Preferred Donation Method

Payroll Deduction

Check

Cash

Credit Card / Debit

Your Organization's Name:

Your Name

Title

First

Middle

Last

Suffix

Your Contact Information

Phone

Address

City/Town

State/Province

ZIP/Postal Code

Additional Donor Information

I am a first-time United Way donor

I have invested in United Way for at least 10 years

I want to receive updates and news from UWLC via my e-mail address

Check Donors

Amount of Check Donation

Cash Donations

Amount of Cash Donation $

Designations - MINIMUM $100 per designation

Direct My Investment to...

Education Impact Area

Health Impact Area

Income Area

Other…

Agency Name and address

Release my donor information to the designated agency. Your information will NOT be released unless you check this box.

Agreement

My signature below, confirms my payroll deduction request as stated above.

Signature

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