Name Employer Street Address City State ZIP Phone Birthdate Email Your preferred method of payment: Payroll Deduction Bill Me ($100 minimum total pledge) Mail a Check Payroll Deduction Information Amount of your Recurring Contribution: $ Pay periods/year 52 Weekly 26 Bi-Weekly 24 Twice Monthly 12 Monthly Up to $19,999: 1 hour’s pay per month $20,000-$49,999: 1% $50,000-$99,999: 2% $100,000 and up: 3% Mail check to: United Way of Cullman County, P.O. Box 116, Cullman, Alabama 35056 Combine My Gift with Spouse/Partner Spouse/Partner Name Spouse/Partner Employer Designation United Way asks you to leave your gift undesignated. This will allow local volunteers who have spent time studying the needs in our community to allocate the funds where desperately needed. However, if you wish to designate to a specific agency or other United Way, please indicate above. BE A LEADERSHIP DONOR Please check if you would like to remain anonymous Please print how you want your name to appear in recognition materials PLEASE SEND ME: Information on Young Professionals Board Information on Women United Information on Volunteer Opportunities CHECK IF YOU HAVE Included UWCC in your will or estate plan Given to UWCC for 25 years or more Retired or plan to retire within the next 12 months CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Thank you for your support! In accordance with IRS requirements, please keep a copy of your pledge card for your tax records. United Way of Cullman County has not provided any goods or services in consideration, in whole or in part, for this contribution. Information provided to United Way is used only to properly credit your contribution and communicate with you about United Way and related programs. United Way respects the privacy of our contributors and does not sell, trade, or rent your information. If you do NOT want your name released in printed materials or on our website, please check the “anonymous” box on this form. Submit
