Portal Page - Alpha Controls & Services

Welcome to the Alpha Controls & Services Workplace Campaign

When we come together, we can accomplish more than any of us could alone. Your gift supports local programs like United for Literacy, 211, and ALICE. You're helping children and families across Winnebago County.

Complete the form below to make your pledge. Thank you for investing in our community.

Workplace Pledge Card

First

Middle

Last

Preferred Email

This Email Is:

Personal

Work

Preferred Phone

This Phone Is:

Personal

Work

Date of Birth

I'm Retiring (Month/Year)

Month/Year estimate, if known.

Address

City/Town

State/Province

ZIP/Postal Code

I Wish to Remain Anonymous

Yes

Please do not use my name for any recognition purposes.

Name(s) for Recognition

Please tell us what name(s) to use when we thank you in recognition materials (ex: John & Jane Smith)

Preferred Donation Method

Payroll Deduction

Check

Credit Card

Check Donation

Amount of Check

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

Amount of Your One-Time 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

TOTAL: $0

OPTIONAL: Choose your preferred donation area(s)

Please designate my investment to a different United Way or the Winnebago County human service 501(c)(3) organization

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

Name of Organization

Federal Tax ID#

Street Address

City

State

Zip Code

Organization Phone Number

Donation Amount

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.

Signature

Sign above

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