Donate To Your Community Your Name Title First Middle Last Suffix Your Contact Information Email Phone Address City State - None -AlabamaAlaskaAmerican 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 Donation Method Preferred Donation Method Check Cash Credit/Debit Card Check Donation Amount of Check $ Make checks payable to United Way of the Blue Mountains. Please give the check to your Campaign Coordinator within 24 hours of this pledge. Cash Donation Amount of Cash $ Please give your cash donation to your Campaign Coordinator within 24 hours of this pledge. Credit/Debit Card Donation Select One One Time Donation Monthly Recurring Donation Amount of your One Time Donation $ Amount donated each month $ 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: 1 Donation Details Donor Designation Options United Way Community Fund Your best way to help! A gift to United Way’s Community Fund allows you to help more people than a gift to a single nonprofit. 100% of your gift stays right here in our valley. Specific Agency You will be required to provide the agencies contact information. Name of Agency Amount to Agency $ Full Mailing Address of Agency Do you want to designation to an additional agency? Yes No Additional Agency Designation information Provide the Name, Address and Amount for any additional agency. Please share my information with my selected United Way and/or Agency Yes No Recognition Please list me in recognition materials I wish to remain anonymous Donor Notes You are invited to identify your local United Way so that 100% of your donation will go to your local United Way Community Fund, unless you designate another charity below. My signature below, confirms my pledge as stated above. Signature Sign above What color is the sky? Leave this field blank
