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United Way of Clinton County |
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| 31 W. Main St. Wilmington, Ohio 45177 Call 937-383-4846 or Fax 383-0956 *51 start via email...Request form from: unitedwaycc@in-touch.net or print from www.unitedway-clinton.org | ||
| Firm/Organization Name:_______________________________ Mailing Address:____________________________________ Phone:__________________________________________ |
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Contributions Reported | ||
| Total Corporate Gift | $ ___________ a) total amount contributed |
$ ___________ cash/check enclosed |
| Contributions Fully Paid # of contributors |
$ ___________ b) |
$____________ |
| please paper clip donor pledge (cash or check) to donor card for which it applies | ||
| Payroll Deduction # of contributors |
$_____________ c) |
$____NA________ |
| employer should keep a copy of pledge card employee should keep a copy of pledge card original pledge card should be returned to United Way of Clinton County with this form | ||
| Total Employee Contributions Total b & c # of contributors |
$_____________ d) |
$____________ |
| Total Corporate & Employee Giving Total a & b |
$_____________ e) |
$____________ |
| Please check appropriate box: This is a _____ Partial Gift or _____Final Report | ||
| Total Number employed by Company/Organization #___________ | ||
| Person Completing this Report _____________________ Date __________ | ||
| Title _______________________ Phone _____________ | ||
| for United Way Use only : Date Received | Posted ___________ Initials ___________ |
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