Your Gift Helps So Many

Seniors... children and youth... people with disbilities - all of these groups and more are supported through the United Way and our funded agencies and their services across Renfrew County. From prevention, to counseling, to crisis intervention, your gift to the United Way is truly the way to help people who need it most.

Personal Information

Title: *

First Name: *

Initial:

Last Name: *

Home Address: *

Address Cont.:

City: *

Province: *

Postal Code: *

Business Phone: *

Home Phone: *

Business Email:

Home Email:

How I Want To Give

By Single Donation

How much to donate?: * $

Payment Options**:

** If the preferred option of payment is by cheque, please download and complete this form and mail to: Renfrew County United Way, 1330 Pembroke Street West, Unit B, Pembroke, Ontario K8A 7A3. Cheques payable to Renfrew County United Way.

Credit Card Number:

Expiry Date:

Name as it appears on the card:

By Multiple Donation

How much to donate?: * $

Payment Options**:

** If the preferred option of payment is by cheque, please down load and complete this form and mail to: Renfrew County United Way, 1330 Pembroke Street West, Unit B, Pembroke, Ontario K8A 7A3. Cheques payable to Renfrew County United Way.

Credit Card Number:

Expiry Date:

Name as it appears on the card:

Payment Schedule:

Starting:

By Payroll Deduction

I would like to contribute the following amount each pay:

How much to donate?: $

X Number of pays:

TOTAL: $

Starting:

Name/Mailing Address of Employer:

*** If you are donating by payroll deduction, please provide a copy of this form to your HR or Finance Department for processing.

Signature: *

Note: Tax receipts for non-payroll deduction gifts of $20 or more will be automatically issued when received (post-dated cheques will be receipted as of the date of the cheque). Gifts by payroll deduction are recorded on employer-issued T4 slips - no income tax receipt will therefore be provided.

Date: *

I Wish to Support the United Way

Donation Amount: $

Of my total donation stated in section “How I Want to Give”, I want the following amount to go to the United Way.

United Way Name:

Indicate the United Way name or the city/province in which it is located below.

City/Province:

I Wish to Support Another Charity

Donation: $

Of my total donation stated in section “How I Want to Give”, I want the following amount to go to another charity in Canada.

Charity Name:

City:

Province:

Postal Code:

Charity Registration Number:

Charity listings - www.cra-arc.gc.ca/chrts-gvng/lstngs/menu-eng.html

Anonymous:

Do you wish your name to be released to the charity indicated?

My Leadership Gift

Donors who give $1,000 or more receive recognition as a ‘Leader’ .

List me by name:

Do you wish to be publicly listed in United Way recognition material this year?

If yes, list me as:

Campaign Goal

The United Way’s 2016 campaign goal is $405,000

As of February 19, 2016 we have $345,718.00 in pledges.

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