Your Gift to United Way Matters! And Every Donation Counts! WOMEN UNITED DONATION FORM Your Contact Information Your Name First Middle Last Work Email Personal Email Phone Number Your Contact Information Address Address 2 City State GeorgiaAlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP Code Occupation Employer Recognition This is a joint gift with my Spouse/Partner (Mark if applies) Name of Spouse/Partner Company of Spouse/Partner List My/Our Name in publication as: × Status message Women United Ambassadors: $500-$999 Women United Leaders: $1,000-$4,999 Beverly Knight Olson Society: $5,000-$9,999 Women of Tocqueville Society: $10,000+ Donation Options Donation Method Check Credit/Debit Card Stocks or Securities Check Donation Checks may be made payable to United Way of Central Central Georgia and mailed to: P.O. Box 1302 Macon, Georgia 31202. Amount of Check $ 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. Select Card Occurence One Time Donation Monthly Recurring Donation Quarterly Recurring Donation Amount of One-Time Donation $ Monthly Contribution Options $5/month ($60 annual) $10/month ($120 annual) $25/month ($300 annual) $50/month ($600 annual) $100/month ($1200 annual) $250/month ($3000 annual) Quarterly Contribution Options $50/quarter ($200 annual) $125/quarter ($500 annual) $250/quarter ($1000 annual) $500/quarter ($2000 annual) $1000/quarter ($4000 annual) $1250/quarter ($5000 annual) 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 ANNUAL TOTAL: $ 0 Update 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. I qualify for the Caring Club Card Designations Choose Where to Make an Impact Women United Fund United Way of Central Georgia Programs & Initiatives Read United Birth Through Eight Community Schools United Brookdale Resource Center Pink Promise United Mission United Birth Through Eight Initiatives The Basics First Steps Parents As Teachers Dolly Parton Imagination Library Other: Donor Notes Additional Donor Details Mark all that Apply I am a first time donor Loyal Contributor Are you a Leadership Giver? I am interested in being a volunteer How many years have you contributed? Agreement My signature below, confirms my pledge to Women United. If donating by credit card, place your signature below, and click on proceed to payment page and fill out credit card payment form. Signature (press down and drag your cursor inside the box to sign) Reset Date Proceed to Payment Page Submit
