2023 Sample Pledge Form

Welcome to the {enter company} 2023-2024 United Way of Central Georgia Workplace Campaign!

{insert company logo}


Your Gift to United Way Matters!  And Every Donation Counts!

3 a week
5 a week
10 a week
25 per week


Your Contact Information
Donation Options
Payroll Deduction
Check Donation
Cash Donation
Credit/Debit Card Donation

Once you finish this form, you will proceed to the payment form to process your credit/debit card. Be sure to enter the same amount on the payment page as you enter on this form.


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!

Stocks or Securities

Please call 478-621-7798 for more information!

Total Annual Contribution
Caring Club Card

Enjoy Special Rewards!

By donating $156 ($3 a week) or more annually, you automatically enjoy the rewards of a Caring Club membership. You will receive great discounts on food, entertainment and valuable services.

Birth Through Eight Initiatives
Additional Donor Details
My signature below, confirms my payroll deduction request as stated above. If donating by credit card, place your signature below, and click on proceed to payment page and fill out credit card payment form.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.