Tocqueville Society Pledge Form

My Contact Information

Name(Required)

Preferred Communication Name

Home Address

Phone

Mobile or Work Phone

Mobile Phone

Work Phone

Email(Required)

Personal or Work Email(Required)

Personal Email

Work Email

Preferred Communication(Required)

Phone

Employer

Title

Birthdate

Spouse/Partner Contact Information

Name

Preferred Communication Name

Phone

Birthdate

Employer

Title

Recognition

Our policy is to use formal first name/spouse formal first name and last name for roster and publications.

My Pledge

Please enter your total pledge amount:(Required)

I want to support United Way's initiatives:

Community Building Fund:

Mental Health:

Education:

Community Stability:

Healthy Aging:

Women United:

I wish to allocate a portion of my gift to*: (optional)

Please list the amount(s) and the name(s) of the organization(s):

*Any external organization you select must have IRS Tax Exempt 501(c)(3) status and have health or human services as its primary mission. United Way will process all gifts and forward them to eligible agencies. Results from external designations are not tracked and measured by United Way. The 14% charge to cover supporting costs is waived for our Tocqueville Society members. As of July 1, 2016, a minimum investment of $2,500 to the Community Building Fund is required in order to qualify for Tocqueville Society.

Payment

Payment:(Required)

Signature(Required)

By typing your name below, you agree that your typed name will serve as your electronic signature, and you acknowledge that all the information provided is accurate and truthful to the best of your knowledge.

Optional Information

Planned Giving

Which of the following best describe you?

Name

This field is for validation purposes and should be left unchanged.