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United Way Donation Form - 2015

Fill out this form to donate funds through payroll deduction(s) to the United Way. A receipt will be delivered to your department in January and your payroll deduction(s) will begin with the 1/08/14 paycheck.

* Indicates required information

Please provide the following information to help us best serve you.

First Name *
Middle Initial *
Last Name *
Email *
Department *
Phone *

1. *
Employee Number (Not your badge #)
2.

Payroll Deduction - Per Pay Period $ (NOTE: Annual donation will be this amount x 26 PPs) Enter Per Pay Period Number only (no additional notes or characters)

3.

One Time Payroll Deduction (Numeric entry only)

4.

PDO Deduction - You must have a balance of at least 96 PDO hours in order to be eligible to donate PDO hours. A request that brings your PDO balance below 96 hours will not be processed. Enter the number of hours you would like to donate. (Numeric entry only)

Instruction PLEASE TELL US HOW YOU WANT TO HELP.
5.
Option A - Community Impact Fund

I wish to invest in the Community Impact Fund so my gift will support a broad range of services to help people in the Cape Fear area. (Select all that apply)
     
6.

Option B - Designated Gift ($100.00/yr minimum) I want my gift to go to a specific charity that United Way supports. List Name of Agency(s) and amount to go to each agency.

7. *
You can release my name to the charities I have designated.
 
 
8.
Special Notes about my donation, or if this is a joint / combined gift then please list the second donor's name here.

 
 
2131 S. 17th Street, Wilmington, NC 28401  |  910.343.7000