Donate via Credit Card

Your recurring contribution will be processed automatically. You can specify the number of installments, or you can leave the number of installments blank if you want to make an open-ended commitment. In either case, you can choose to cancel at any time. You will receive an email receipt for each recurring contribution.

Donor Information

Title (Mr., Mrs., Ms., Dr.)

First Name *

Middle Initial

Last Name *

Male or Female

Personal Email

Spouse's First and Last Name

Spouse's Email

Street Address (Home)

City (Home)

State (Home)

Postal Code (Home)

Phone

Phone Number *

Employer

Credit Card Information

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Donation Details

Select One: *

Please choose how you want to invest in your community:

Leadership Giving

Alexis de Tocqueville ($10,000 plus)

Leadership Circle ($1,000 – $9,999)

Women’s Leadership Council ($1,000 plus)

Young Leaders Society ($365 plus)

Lasting Legacy (please contact me about how to include United Way in my estate plans)

My gift qualifies me for membership in the above listed societies (check all that apply)

This is a Corporate Gift

Yes

Name of Corporation

This gift is in memory or in honor of:

Donate via Credit Card

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