MY INFORMATION*

Please print and sign firmly in blue or black ink.

Mr.



Ms. FIRST NAME

Mrs.

M.I.





LAST NAME



HOME ADDRESS

Home Work

PREFERRED PHONE

LOYAL RECOGNITION

Cell

I have given to United Way since: Insert year you began giving



STATE

ZIP CODE

When we keep in touch with you by email, you’ll stay informed and we’ll save printing and paper costs, so more of your contribution goes directly to those who need it.

PREFERRED EMAIL

DOB (MM/DD/YYYY): / /



CITY

SUFFIX

GENDER:

Work Personal

Female Male

EMPLOYER

MY GIFT*



ENCLOSED GIFT



BILL ME ($100 minimum) One time Monthly First billing date: /

Date:

/

/





Semi-Annually

STOCK/SECURITIES

Please call 704.371.6208 when you are ready to transfer funds

Quarterly /

CREDIT/DEBIT CARD ($25 minimum)

One time Monthly Quarterly Semi-Annually First billing date: / / Go to uwcentralcarolinas.org/give to make a secure credit card payment.

Check (payable to United Way) # Cash







I authorize my employer to deduct the following gift from my paycheck: $100 $50 $25 $10 $5 Other $ My # of pay periods per year: 12 24 26 52 Other





PAYROLL DEDUCTION



DONOR ADVISED FUND

I will be recommending a grant from in the amount of $

(institution name)

in the year

.

MY TOTAL ANNUAL GIFT IS: $

*

Please check the accuracy of your entries. Thank you.

I Choose to LIVE UNITED

Leadership Giving

CREATE CHANGE FOR ALL

$

My gift to United Way of Central Carolinas helps create an environment of opportunity for all.



LEADERSHIP CIRCLE



($1,000 - $9,999)



ALEXIS DE TOCQUEVILLE SOCIETY

OR, I CHOOSE TO TARGET MY GIFT TO ONE OR MORE OF THESE AREAS:

IMPACT GRANTS (290)



$

• EDUCATION • HEALTH • FINANCIAL STABILITY • BASIC NEEDS



($10,000 - $14,999)



DIRECTORS CIRCLE



($15,000 - $24,999)

MAJOR GIFTS SOCIETY ($25,000 and up)

I want to GET INVOLVED

UNITED NEIGHBORHOODS (291)

$

UNITE CHARLOTTE (6099)



$



LEADERSHIP CIRCLE STEP UP Year 1 - $500 Year 2 - $750 Year 3 - $1,000

ALEXIS DE TOCQUEVILLE SOCIETY STEP UP Year 1 - $5,000 Year 2 - $7,500 Year 3 - $10,000

(SEE REVERSE FOR MORE INFORMATION)

A-LIST

($1,000) African-American Engagement

LINC

($250) Young Professionals in their 20s



WOMEN UNITED

($1,000) Women Professionals Engagement

YOUNG LEADERS

($500) Young Professionals in their 30s

OPTIONAL DESIGNATED CONTRIBUTION to a United Way approved 501(c)(3) community partner or another United Way. For a complete list of our community partners, visit uwcentralcarolinas.org/communitypartners. Minimum $52 per designation.



COMMUNITY PARTNER

$

NAME ADDRESS



COMMUNITY PARTNER

$



NAME ADDRESS

COMMUNITY PARTNER

$

NAME ADDRESS