Digital Pledge Form

Complete Your United Way Workplace Pledge

You’re in the right place! Simply complete the form below to make your workplace donation. Your gift will be directed through your employer’s United Way campaign.

 

Workplace Pledge Card
This Email Is:
This Phone Is:
Month/Year estimate, if known.
I Wish to Remain Anonymous
Please do not use my name for any recognition purposes.
Please tell us what name(s) to use when we thank you in recognition materials (ex: John & Jane Smith)
Preferred Donation Method
Payroll Deduction
Investment Amount Per Pay Period
$
Employer's Pay Periods Per Year:
Check Donation

Please make checks payable to United Way of Rock River Valley. Give the check to your Campaign Coordinator within 24 hours of this pledge.

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. Thank you!

Total Annual Contribution
$0
OPTIONAL: Choose your preferred donation area(s)
Designations must be a minimum of $100. A designation fee of 5% will be applied. If the designation agency is not easily identified by the information provided, is not a registered 501(c)(3), does not certify as Patriot Act compliant, is no longer in operation, does not meet the minimum requirement, and/or does not cash any checks within one year, your gift will go to where it is needed most in our local community.
Other 501(c)(3) Agency or United Way
$
  • Designations must be a minimum of $100.
  • A designation fee of 5% will be applied.
  • If the designation agency is not easily identified by the information provided, is not a registered 501(c)(3), does not certify as Patriot Act compliant, is no longer in operation, does not meet the minimum requirement, and/or does not cash any checks within one year, your gift will go to where it is needed most in our local community.
Agreement

My signature below confirms my pledge as state above.

Sign above
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