Pledge Form : Workplace Campaigns : Get Involved : United Way of Lamoille County

Name

Address

City

State

Zip

Phone

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Company

I authorize my employer to deduct this amount from each paycheck:

I am paid:

My total yearly gift is:

Duration of payroll deduction:

SAVE THE PAPER & POSTAGE. (Gifts over $250 automatically receive acknowledgement).

I prefer to make a one-time donation by check (given to HR Dept.)

I would like to designate my gift to another 501(c)(3) health and human service agency. (Note: $100 minimum donation)

Pledge Form