Pledge Card

Workplace Campaign Pledge Form

Thank you for your support of United Way of Indian River County

Company Name

Label

Cash
Check

Card

Payroll Deduction

I authorize my employer to deduct:

My pay period is:

Twice a month (24)
Every two weeks (26)
Weekly (52)
One Time (1)

Dontae Today By Credit Card

I am a Loyal Contributor (years do not have to be consecutive). I have contributed to any United Way for 10 years or more.

Yes
No

Leadership Gifts of $1,000 - Please list my/our name(s) as follows

recognition

I prefer that my gift remain anonymous

First Name

Last Name

Email

phone

Street Address

City

State

Zip

I'd like to sign up for e-newsletters!

Yes

E-Signature - sign below with your mouse or finger

A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE. FL. DEPT. OF AGRICULTURE & CONSUMER SERVICES REGISTRATION #CH958.