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Community Campaign Use Only: Company ID # Envelope # Initials THANK YOU! United Way Community Campaign • 30 Laurel Street • Hartford, CT 06106-1374 • (860) 493-6800 • FAX (860) 493-6859 • unitedwayinc.org OTHER PLEDGE METHODS: Donor Relations: Staff/LE Name: __________________________________________ Date: __________________________________________________ United eWay Campaign use only: Uploaded By/Date________________________________________ GRAND TOTAL FOR ENVELOPE CAMPAIGN YEAR:
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# of Employees in organization:
# of donors giving $1,000 or more in this envelope:
Please do not mail this envelope. Call (860) 493-6800 for pick-up.
THANK YOU! United Way Community Campaign • 30 Laurel Street • Hartford, CT 06106-1374 • (860) 493-6800 • FAX (860) 493-6859 • unitedwayinc.org
(Community Campaign use only)
Donor Relations:Staff/LE Name: __________________________________________Date: __________________________________________________United eWay Campaign use only: Uploaded By/Date________________________________________
Finance Department:Deposit Date: _________ Credit Date: _________ Deposit ID#: _________Audited By: _______________________________ Date: _______________Processed By: _____________________________ Date: _______________Date Posted: ___________________________________________________
Partial Report Full Report Retiree Report eWay Report
Organization NameStreet AddressCity State Zip
United Way Community Campaign
RepoRt envelope
STEP 1: GIFT INFORMATION
CONTRIBUTIONS/PLEDGES # OF GIVERS TOTAL AMOUNT AMOUNT ENCLOSED
Payroll Deductions (Employer retains signed yellow forms. Please enclose white forms) *
OTHER PLEDGE METHODS:
Check / Cash (Please enclose white forms and checks payable to United Way Community Campaign.)*
Credit Card (Please enclose signed white forms with addresses) *
To be billed by United Way (Please enclose signed white forms with addresses) *
Stock (Please enclose signed white forms with addresses) *
SUBTOTAL
Corporate Pledge
GRAND TOTAL FOR ENVELOPE
* Please use Special Event Report Envelope for event funds.*
STEP 2: CAMPAIGN COORDINATOR INFORMATIONName Signature
Date Phone Email
STEP 3: BILLING INFORMATION, IF APPLICABLEBilling Address Phone
Contact for company billing questions Email
Community Campaign Use Only: Company ID # Envelope # Initials
CAMPAIGN YEAR:
Special Gifts Batch Control Number
Notes:
For Community Campaign use only:
Envelope # Description/Comments:DateAdjusted To /From
0512-2K
ATTENTION: Company CoordinatorPlease complete the face of the envelope,
seal it, and sign across the flap.
Thank you for your cooperation!
