If you choose to care for our community through a contribution to United Way of Lake County, please complete the information below.

Your credit card is not charged until AFTER you are contacted by a United Way of Lake County Representative.


Full Name    Employer
Address   
City State Zip Code
Telephone Number
Email address

My investment in the community is $

My method of payment is
   Please bill me in full. Payable in 30 days.
   Payment by check - Make check payable to United Way of Lake County
         Mail to: 9285 Progress Parkway, Mentor, OH 44060                                   
   Please bill me at home quarterly (minimum pledge of $50.00).
   Please bill my Credit Card quarterly.
   Please bill my Credit Card in full.
                 Master Card
                 VISA
                 Discover
    Credit Card information is obtained by United Way of Lake County during
a follow-up telephone call subsequent to receiving your pledge via email.
                 
 Please record any comments or special instructions
 

This section is optional:
I choose to direct my gift to one of the community impact areas:
   Investing in children and families    
   Improving health and wellness
   Caring for people in crisis               
   Caring for our senior citizens

Other designations:
    Other United Way (minimum of $50.00)         $
        Please specify

Specific Care - Please direct my gift to a specific Northeast Ohio health and human service
501(c)3 non-profit agency ($50.00 minimum)
  Name    
  Address
  City, State and Zip Code

                                  Thank you for investing in what matters in Lake County!
                    A Campaign Representative will be in contact with you by telephone/email.
                                             No goods or services were provided to you by United Way in exchange for this contribution.