BSU United Way Pledge Card

Items with an * indicate a required field.

Last Name *
First Name *
Middle Initial *
Employee ID Number *
BSU Department *

Address Line 1
Address Line 2
City
State
Phone *
Zip
Email
	I do not wish to pledge to United Way this year.
I wish to pledge using payroll deduction and have completed the BSU payroll authorization card. My total pledge is:
Please indicate full amount in dollars and cents (i.e.: $00.00).
I wish to make a one time pledge/gift by cash or check.
Please indicate full amount in dollars and cents (i.e.: $00.00).
I wish to pledge/give by United Way Quarterly Billing Plan. Please mail the statement to the department or address listed above. My total pledge is:
Please indicate full amount in dollars and cents (i.e.: $00.00).
	I/we have pledged $1,000 or more. Please include me/us as Leadership Givers. If you and your spouse/partner's combined gift equals $1,000 or more, as a couple you qualify as Leadership Givers. To assist with record keeping, please answer the next four
My/our total combined pledge is:
Spouse's/partner's name is:
Spouse's/partner's employer:
Please indicate how you wish your name(s) to be listed in the Pathfinder registry or if you wish to remain anonymous.

I would like to designate all or a portion of my gift to one or more specifc member agences.
I would like to designate all or a portion of my gift to a United Way office in other counties/community. Please indicate the amount of your gift and the name and address of the agency you wish your contribution to be sent.
Do you wish to receive acknowledgment of your gift? Your acknowledgment will be mailed to the address you have indicated on this card. *	Yes No

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Alpha Center
American Red Cross
Big Brothers/Big Sisters
Boys & Girls Club
Boys Scouts of America
Bridges Community Services
Cancer Services of Delaware County--Little Red Door
Family Services
Gateway Health Clinic
Girls Scouts of Central Indiana
Hillcroft Services/Isanogel Center
Huffer Memorial Children's Center
Meals on Wheels
Mental Health Association
Motivate Our Minds
Muncie Delaware County Sernior Citizens Center
Muncie Mission
Open Door/BMH Health Clinic
Open Door Community Services
Rebuilding Together
Salvation Army
Second Harvest Food Bank
Unity Center
United Day Care Center
YMCA
YWCA