EMPLOYEE COMMITMENT FORM

2. Pay in Full with Cash/Check: Enclosed, made payable to “River Region United Way” ..............................$

3. Bill Me: Minimum $50 annual gift. Home address required above. ............................................................. $

For option 3, bill me: One Time Monthly Quarterly

COMMITMENT FORM

Please print and sign in blue or black ink. Your personal information, including email, is held in strict confidence and will not be shared.1. MY INFORMATION

Designations (optional)

2. MY GIFT

1. Easy Payroll Deduction:Amount per pay period ( $100, $50, $30, $15, $10, $___ )

x = $No. of pay periods in full year: (every 2 weeks = 26, twice/month = 24)

Total

My gift, above, qualifies me for recognition as a LIVE UNITED Leader. (See back of pledge form for more about being a LIVE UNITED Leader. Check all that apply)

Fair Share Leader: I will give 1 hour’s pay/week or 1% of my annual salary

Everyday Hero: I will give $1 a day or $365 annually Feather Societies: My gift is between $500 - $4,999 Dexter Society: My gift is between $5,000 - $9,999

Donor Recognition Levels

Mr./Mrs./Ms. First Name M.I. Last Name

Home Address City State Zip Code

Home Telephone Email Address* (please check one)

Ext. Company Name / EmployerWork Telephone

*Help us go green! To keep costs low, we email acknowledgement letters.

$10 per pay period can feed a homeless family of four for two weeks.

$2 per pay period can provide two days of hot, nutritious meals for a homebound senior.

$5 per pay period can cover three therapeutic riding lessons for a rider with a disability.

Serving Autauga, Elmore, Lowndes, Macon and Montgomery Counties

I wish to designate my gift to an affiliate agency. (To designate your gift, please see instructions on separate Affiliate Agency Listing. $25 minimum designation per agency.)

to affiliate agency to affiliate agency$ $# #

Home Work

4. Debit/Credit Card: To make your gift, call River Region United Way at 334.323.2543 or give securely online at www.RiverRegionUnitedWay.org/Donate ............................................ .................

Debit/Credit Cards Accepted:

$

I prefer to remain anonymous on United Way donor recognition lists.

Step up and be a LIVE UNITED Leader

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To learn more about the impact of your gift in our community, visit RiverRegionUnitedWay.org

Apt.

After making your gift using a debit or credit card, please fill in the amount of your gift and return this form to your Employee Campaign Coordinator.

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If an agency you designate to is not a qualified 501(c)(3) tax-exempt organization, if the information is incomplete or if your designation is less than $25, your gift will be redirected to the Local Community Fund. In addition, the designated agency must comply with the USA Patriot Act.

If you have questions about the processing of your gift, please call 334.323.2543.

River Region United Way operates in accordance with the highest standard of accounting practices. Our annual report and audited financial statements are available on our web site at www.RiverRegionUnitedWay.org/accountability.

EVERYDAY HERO

“I drive for other seniors a few days each week. But I give $1 every day to United Way to drive change in my community.”

$1 a day = $365 each year

FAIR SHARE“I work an 8-hour shift at the health clinic, but one hour’s pay a week goes to United Way to care for my whole community.”

1 hour’s pay/week or 1% of annual salary

BE A LEADER. STEP UP AND CHANGE LIVES. LIVE UNITED. Be a LIVE UNITED Leader based on the total amount of your gift or on the amount as a percentage of your income.

Mailing your commitment form?

River Region United Way P.O. Box 868Montgomery, AL 36101phone 334.264.7318

Over 40 Agencies. One Mission. Advancing the Common Good in the River Region.

FEATHER SOCIETIES

“I build cars most days of the week, but all year long I’m building a better community by donating at least $500 annually to the United Way.”

Be a LIVE UNITED Leader

Like us on Facebook – “River Region United Way”

River Region United Way acknowledges no goods or services were provided in exchange for this contribution. For tax purposes, please use your final paystub of the year as documentation of your charitable gift. Consult your tax advisor for more information.

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