CORPORATE COMMITMENT FORM

CORPORATE COMMITMENT FORM

1. MY COMPANY INFORMATION

DATE4. MY sIgNATuRE(Required)

2. CORPORATE COMMITMENT CONFIRMATION

Challenge Match:

Check enclosed

Please bill us starting on the following date:________________________

Check one: One time bill Monthly Quarterly Other ____________

Company Name

Address City State Zip Code

Work Telephone General Work Email (ie: info@yourcompany .com)

Company Contact Name

RiverRegionUnitedWay.orgServing Autauga, Elmore, Lowndes, Macon, and Montgomery Counties

Please return your Corporate Commitment Form to your Loaned Executive, fax or mail directly to River Region United Way at:

River Region United WayP.O. Box 868Montgomery, AL 36101Fax Number: 334.264.7485Phone Number: 334.264.7318

Company Account Number Year

We are proud to support the River Region United Way Campaign and we commit to:

Match employee gifts by $_____________ per $1 donated

Other (please explain)_______________________________________________

Specific Gift in the Amount of: $_____________________________________

(for RRUW use only)

Company Contact Work Email

Company Contact Work Telephone No. of Employees,

3. PAYMENT OPTIONs

Extension

River Region United Way/Autauga CountyP.O. Box 680293Prattville, AL 36068Fax Number: 334.361.0569Phone Number: 334.365.3243