Pledge Form

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Pledge Form

First Name:
Last Name:
Employer:
Street Address:
City:	State:
ZIP:
Phone:	Date:
E-mail:

MY COUNTY OF SPECIAL CONCERN IS
Antrim Grand Traverse Kalkaska Leelanau All four counties

You may choose one or any combinations of the following options.
Please make sure your choices do not exceed your total gift.

My Gift to United Way $

My Targeted Gift to United Way
I want my gift to address specific community goals. Please direct my contribution
to United Way funded programs that do the best job of accomplishing the goal(s) I have indicated below.

...gives our youth what they need to succeed. $

...provides critical human services. $

...ignites fresh ideas to help more people $

My IMPACT 1000 Gift $
My gift of $1000 or more qualifies me for membership in IMPACT 1000,
whose members will chose and award a major grant.

My Gift to the Volunteer Endowment Fund $
I want my gift to be placed into United Way's permanent endowment. The interest
income will be used to support volunteer initiatives in our region for many years to come.

Specific Request I want to send a gift directly to the following tax-exempt organization(s)

Organization name #1 $

Organization name #2 $

MY TOTAL GIFT IS $

(Please make sure this number matches your total pledge amount)

We will bill you at home for your pledge.