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Individual Gift – SURFACE MAIL OPTION

Please print the form below, complete the requested information, and mail it to

Centre County United Way
2790 West College Avenue Suite 7
State College, PA 16801

Donor Information

Name________________________________________

Address______________________________________

City_________________________State___Zip_______

E-Mail Address_________________________________

Daytime Phone_(_____)___________________

If your company conducts an employee campaign for United Way, do you wish to have this pledge reflected in their total?

Y es - Employer name____________________________
No

Donor Options

General Fund - to be divided among United Way member agencies.

Amount $________

Designated Gift

Agency Name____________________

Amount $________

Other United Way:

Location_______________

Amount $________

(Note: Designations must be for a minimum of $50, and made to a health and human service provider in Centre County. United Way cannot guarantee the use of these contributions. Designations less than $50 will be added to the General Fund.)

Payment Options

Enclosed is my check to Centre County United Way, 2790 West College Avenue #7, State College, PA 16801

I will pay by credit card:

Visa
Mastercard
American Express
Discover

Credit Card #: ______________________________

Expiration date:______________________________