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live united

®

TELL US ABOUT YOURSELF Mr/mrs/ms/dr

first name

suffix

last name

MI

home address

suite/apt no state

city

zip code

home phone

employer

Last year’s contribution $___________ Gender

Female

what year did you first give or volunteer at any United Way? ……

work phone

Work email address

male

Please contact me about how I can improve lives in our community by creating a legacy gift for the future.

HOME email address

Signature (required to process pledge)

Date

make your contribution Total Contribution: $

(for contributions of $1,000 or more, join Leadership Circle in Step 3)

…… Easy Payroll Deduction Per Pay Period:

$50

$25

$10

$7

Other $

No. of Pay Periods:

For your tax records, the IRS requires you to keep a copy of this pledge form along with your payroll receipt, W2 or other employer documents to verify any payroll amount withheld and paid to United Way.

FOR UWCI USE: # date: …… One Time Contribution (enclosed): Check (payable to United Way) or Cash $ Monthly Quarterly I wish to give this amount per payment: $ Begin billing (mo.) (yr.) …… Credit/Debit Card Once Visa MasterCard AmEx Discover Account No. Exp / (MM / YY) …… Stocks/Securities Appreciated stocks and securities might provide tax benefits. Please call 515-246-6511 to facilitate. …… Intend to Recommend from a Donor-Advised Fund …… Please Bill Me (A home address and minimum contribution of $50 is required). Begin billing (mo.) (yr.)

Join leadership circle

Tocqueville Society: $10,000 + Gold Bridgebuilders: $5,000 Silver Bridgebuilders: $2,500 Partners in Leadership: $1,000

…… This is a joint contribution with my spouse/partner. Spouse/partner name_____________________ Employer___________________________ Please list me/us in recognition materials as _______________________________________

I/We wish to remain anonymous in recognition materials.

Tocqueville Society (TS) members are leaders among leaders. TS recognizes those who contribute $10,000 or more.

Women’s Leadership Connection (WLC) supports strategies to improve kindergarten readiness.

Education Leadership Initiative (ELI) supports strategies to ensure youth succeed in school.

…… I am/We are joining or renewing our TS membership with a contribution ($10,000 or more). …… I am/We are participating in the TS step-up program and I/we commit to continue the step-up program as shown on the back.

Please direct $___________________ to WLC.

Please direct $___________________ to ELI.

…… I am/We are joining or renewing our WLC membership at the Lead level with a $2,500 (minimum) contribution to WLC. …… I am/We are joining or renewing our WLC membership at the member level with a $1,000 (minimum) contribution to WLC. …… I am/We are participating in the WLC step-up program and I/we commit to continue the step-up program as shown on the back.

…… I am/We are joining ELI at the Lead level with a $2,500 (minimum) contribution to ELI. …… I am/We are joining or renewing our ELI membership at the member level with a $1,000 (minimum) contribution to ELI. …… I am/We are participating in the ELI step-up program and I/we commit to continue the step-up program as shown on the back.

Find more information about TS, WLC and ELI on the back of this pledge form.

This amount will be directed to improve kindergarten readiness before any other optional agency contributions listed below.

This amount will be directed to school success before any other optional agency contributions listed below.

This section OPTIONAL. $50 minimum required for a donor-directed contribution to a specific agency. An administrative fee will be deducted. For more information, please refer to our web site at www.unitedwaydm.org/designations. Please direct $ Please direct $

to specific agency (name) to specific agency (name)

WHITE COPY: UNITED WAY

Do not release my name with this donation. Do not release my name with this donation.

PINK COPY: EMPLOYER

YELLOW COPY: DONOR


live united® Your United Way of Central Iowa contribution, when not directed to a specific agency, will build a stronger community through EDUCATION, INCOME and HEALTH, the building blocks to a better life for all. Join us in making this bold vision a reality for everyone.

ABOUT TS, WLC and ELI To join, please see front side, step 3. United Way of Central Iowa Tocqueville Society (TS) Recognizes exceptional individuals and families who lead the way. Benefits include: • Recognition in United Way of Central Iowa’s Community Report and on its web site • Timely communications about the results of your investments • Invitation to Tocqueville Society events United Way of Central Iowa Women’s Leadership Connection (WLC) Connects women who want to ensure children begin kindergarten ready to learn. Benefits include: • Networking and volunteer events • Annual community recognition and photo recognition for Lead WLC in the Des Moines Business Record and The Des Moines Register • Recognition on the United Way of Central Iowa web site • Regular e-communications related to WLC investments and activities United Way of Central Iowa Education Leadership Initiative (ELI) ELI helps ensure that youth succeed in school. Benefits include: • Networking opportunities with community and business leaders • Professional development and volunteer opportunities • Annual community recognition and photo recognition for Lead ELI in the Des Moines Business Record • Recognition on the United Way of Central Iowa web site • Regular e-communications related to ELI investments and activities Become a Member Today Step-up your contribution over three years. Enjoy networking, learning and volunteer opportunities now. Tocqueville Society ($10,000) WLC and ELI Lead ($2,500) WLC and ELI Member ($1,000) Step-up Your Contribution $ $ 1,500 minimum $ 500 minimum 5,000 minimum Year 1 $ $ 2,000 $ 750 7,500 Year 2 $ 10,000 $ 2,500 $ 1,000 Year 3

Our Commitment to You United Way of Central Iowa will not sell, rent or loan your information and does not provide goods or services as whole or in partial consideration for any contribution.

1111 Ninth Street, Suite 100 Des Moines, Iowa 50314 515-246-6500 www.unitedwaydm.org


2011 Pledge Commitment Form  

Every employee should get a copy of the current pledge form (unless you're using an electronic pledging system). This three-piece carbon cop...

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