| 2011 United Way General Payroll Deduction Form |
United Way of Wise County
300 N. Trinity, Ste C
P.O. Box 213
Decatur, TX 76234
Tel/Fax 940.627.2111
uway@ntws.net
www.wisecountyunitedway.org
2010-2011 Pledge Form Campaign: To Advance the Common GoodTO: Payroll Department
FROM: Employee Name ____________________________________
Employee ID ____________________ (if applicable)
ABSOLUTELY! You can count on me! I Choose to " LIVE UNITED"
Here’s my pledge to help our youth, our elderly and our neighbors in need.
TOTAL ANNUAL PLEDGE: ___________________________
Option 1 - Payroll Deduction, Percentage per pay period:
Please deduct the following checked item from my regular paycheck:
__ 1% of salary __2% of salary __1 hours pay/mo __2 hours pay/mo
Beginning with the pay period __________________
Option 2 – Payroll Deduction, $$ per pay period:
Please deduct $_________ from my regular paycheck
Beginning with the pay period __________________
Option 3 – One-time Payment:
Please forward attached check for $___________ to United Way of Wise County.
(Check should be made out to “United Way of Wise County”.)
Standard designation: The United Way of Wise County Community Fund.
Optional designation: Please designate my contribution to __________________________.
Signature: ________________________________________
Thank you! Your contribution is very important to the people of Wise County. Please return completed form as soon as you can to your Payroll Department.
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Executive Director: Martin Woodruff
P.O. Box 213 / 300 No. Trinity Ste. C / Decatur, TX 76234 / Voice & Fax (940) 627-2111 / Office (940) 627-3684
Director - uwwise.ed@embarqmail.com Webmaster - barbarahaley@centurylink.net
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