United Way of Southwest Colorado

Pledge Form

To print pledge form and mail-in donation, Click here

To donate on-line, complete and submit the following form:
Asterisks (*) indicate required fields.

General Information

*First Name

*Last Name

Mailing Address

City

State

Zip

Home Phone

Daytime Phone

Company Name

*E-mail Address

Your privacy is guaranteed. We will never give, lease or sell your personal information. For United Way SWCO use only.

Please select Payroll Deduction, One-time Gift or Automatic Back Withdrawl

Easy Payroll Deduction

I want to contribute the following amount each pay peried:

$10

$20

Other amount $

(per pay period)

How many times are you paid per year:

	24 (paid two times each month)
	26 (paid every two weeks)
	12 (paid once a month)
	52 (paid once a week)

Employer

My total pledge is $

to United Way of SWCO's campaign.

For total pledge amount, multiply amount per pay period times number of pay periods.

One-Time Gift

My total pledge is $

to United Way of SWCO's campaign.

One-Time Gift to be paid by:

Personal Check (enclosed)

Please make checks payable to: United Way of Southest Colorado

Credit Card

NOTE: Pledge must be $50 or more to use credit card payment option

Card Type:
Card Number:
Expiration Date:
CCV:
Billing Address Zip Code:
Cardholder's Name:

Auto Payment - choose this option, or Click Here to go to the Auto Withdrawl form

	Please send me a receipt for my contribution.
	Not applicable for contributions made through payroll deduction

Please choose how you want to invest in your community

Influence the condition of all. United Way Community Fund.
The most powerful way to invest your contribution. A gift here supports all agencies listed in the brochure in your community.

Amount $

A Specific United Way Partner Agency
Designate your gift to one or more partner agencies. See brochure for a list of agencies in your community.

Agency		Amount $
Agency		Amount $
Agency		Amount $

Other (Non United Way Agency)

Agency
Address
City	State	Zip
Amount $

Do not release my name to designated agency

NOTE: If you wish to contribute to an agency that is not a United Way partner agency, the agency MUST BE a 501 (C) (3) tax exempt organization. The gift must be at least $50 annually. All contributions are subject to the United Way administrative cost of 12%.

Interested in Volunteering or Advocating?

Please contact me regarding		Volunteer Opportunities
		Advocating for causes important to people in Southwest Colorado

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