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Thank You For Helping Build A Better |
What you
give is up to you. |
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NAME OF CONTRIBUTOR__________________________ ADDRESS______________________________________ CITY / STATE__________________ ZIP CODE_________ SIGNATURE___________________ PHONE___________ |
PAID NOW $________________ BALANCE DUE $____________ GIFT ATTACHED (Cash or check payable to United Way) |
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THANKS FOR SHARING! IF YOU CONTRIBUTE $25.00 OR MORE, YOU MAY DESIGNATE THENON-PROFIT ORGANIZATION TO RECEIVE YOU DONATION Name of Organization__________________________________________ Address_____________________________________________________ City/State/Zip_________________________________________________ |
CHARGE TO VISA/MASTERCARD Card no._____________________________ Exp. Date____________________________ Signature____________________________
Date________________________________ |