Thank you for supporting Jefferson County United Way Please use our online pledge card to make your campaign pledge. Your Contact Information Name Company Email Phone Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP Code Donation Method Preferred Donation Method Payroll Deduction Check Cash Bill Me Credit Card Payroll Deduction Contribution Amount Per Pay Period $5 $10 $20 $25 $50 Other… Please enter the NUMBER only $ Number of Pay Periods for Donation One Time 12 pay periods 24 pay periods 26 pay periods 52 pay periods Other… Please enter the NUMBER of pay periods for this donation Check Donation Amount of Check $ Make checks payable to Jefferson County United Way. Please give the check to your Campaign Coordinator within 24 hours of this pledge. Cash Donation Amount of Cash $ Please give your cash donation to your Campaign Coordinator within 24 hours of this pledge. Bill Me Details Frequency of Invoice One Time Quarterly Monthly Amount of EACH direct bill $ Credit Card Donation Amount of your One Time Donation $ After completing this form you will be redirected to our payment page where you will be able to process your transaction in a secured environment. Please be sure to enter the same values that you have entered on this form. Thank you! Total Annual Contribution TOTAL: $ 0 Donation Details Designation Options United Way Community Impact Fund Let United Way volunteers administer funds to the greatest needs in our community. Education Health Financial Stability Mark all that apply I am a leadership donor I'm interested in being a board member I wish to remain anonymous Agreement My signature below, confirms my pledge as stated above. Signature Sign above Leave this field blank
