PERSONAL INFORMATION We never share donor information with outside groups. Salutation - None -Mr.Mrs.Ms.Dr. First Name * Middle Initial Last Name * Suffix Home Address * City * State * Zip Code * Personal Email Address * Cell Phone Number * Date of Birth How many years have you contributed to the United Way? Do you wish to receive e-updates from United Way? Yes No SPOUSE'S INFORMATION Salutation - None -Mr.Mrs.Ms.Dr. Spouse's First Name Middle Initial Last Name PAYROLL DEDUCTIONS Company Name Title/Position Contribution amount per pay period * Number of Pay Periods * Weekly (52 pay periods) Every 2 Weeks (26 pay periods) Twice a month (24 pay periods Monthly (12 pay periods) Annual Contribution * Multiple the amount per pay period by the number of pay periods (Example $10 per pay period x 26 pay periods = $260 annual pledge) Investment Agency Designation (Optional) Provide the agency code above - Click here for a listing of approved agencies and their codes. Comments Thank you for your pledge! CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.