United Way of Virginia's Eastern Shore ! Pledge Fill in Form

P.O. Box 605 Onley, Virginia 23418 (757) 787-5622 fbowers@esunitedway.org

On-Line Pledge Form Printable Fill it in Form here.

I HEREBY CONTRIBUTE THE FOLLOWING AMOUNT TO:

UNITED WAY of VIRGINIA'S EASTERN SHORE
P.O. BOX 605
ONLEY, VIRGINIA 23418
(757) 787-5622

METHOD OF
PAYMENT FOR
UNPAID BALANCE:

QUARTERLY
SEMI-ANNUALLY
ANNUALLY

I WANT MY GIFT OF
$ TO GO TO THIS LOCAL NONPROFIT AGENCY:
(Agency must be a 501(c)(3). If criterion is not met, gift reverts to Critical Community Needs.)

(Agency Name)

TOTAL GIFT
$

PAYMENT METHOD/AMT.
$

UNPAID BALANCE
$

Name:
Address:

SEND BILL BEGIN BILLING ON:

(DATE)

Acknowledgment
Requested

Entering Your Email Address Confirms your Pledge:

(You will receive E-Mail Confirmation of your pledge.) THANK YOU FOR HELPING US TO HELP OTHERS !