Campaign Pledge Card

Workplace Pledge Card

Your Name
Your Contact Information
Donation Method
Payroll Deduction
Check Donation
Make checks payable to United Way of Northwest Connecticut. Please give the check to your Campaign Coordinator within 24 hours of this pledge.
Cash Donation
Please give your cash donation to your Campaign Coordinator within 24 hours of this pledge.
Bill Me Details
Credit Card Donation

After completing this form you will be redirected to our payment page where you will be able to process your transaction in a secured environment. Please be sure to enter the same values that you have entered on this form. NOTE: A $4 credit card processing fee will be added to your donation.

Total Annual Contribution
Donation Details
501(c)3 Organization Designation

United Way will honor donor designation to United Way agency partners, any United Way and/or any 501(c) (3) entity. If your designated agency is not compliance with 501 (c)(3) status or the USA Patriot Act and other counter terrorism laws, United Way distribute the funds via the Community Impact Fund. A 10% processing fee in each designation will be deducted up to a maximum of $100. A minimum annual donation of $104 is required per agency, with a maximum of three designations. Restricted pledges below this amount will be distributed through the Community Impact Fund.

My signature below, confirms my pledge as stated above.