Campaign Resources Campaign Pledge Form Campaign Instructions Campaign Report Electronic Campaign Report PDF Fundraising Activities Stories of Inspiration Funded Agencies 211 Poster Preferred Donation Method Options - Select One Payroll Deduction Check Cash Bill Me Credit Card or ACH Credit / Debit Card Donors: Thank you for your support of the United Way. To complete your donation by credit or debit card - please click here. Payroll Deduction Amount Per Pay Period $ Frequency you are Paid Weekly (52 times/year) Bi-weekly (26 times/year) Semi-Monthly (24 times/year) Other… Enter the NUMBER of contribution times below Check Donation Amount of Check $ Payment Frequency Onetime Monthly Quarterly Semi-Annually Other… Other Frequency Cash Donation Amount of Cash $ Payment Frequency Onetime Monthly Quarterly Semi-Annually Other… Other Frequency Bill Me Details Amount per Invoice $ Frequency of Billing Monthly Quarterly Semi-Annually Annually Date of First Billing Total Annual Contribution TOTAL $0 My Contact Information Title - None -Mr. Mrs. Ms. Dr. First Name Middle Initial Last Name Home Address City State - Select -Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Zip Code Email Address Phone May we include your name in printed materials? Select One Yes, include my name. No, I prefer to remain anonymous. Employer Information Employer - Select -Ashland Community & Technical College American Electric Power/Kentucky Power Air Products AK Steel Ashland Independent Schools Ashland Credit Union AT&T Boyd County Schools Calgon Carbon Carter County Schools City National Bank City of Ashland Clarks Pump N Shop Coca Cola Co Commercial Bank of Grayson Community Hospice Elliott County Schools Fairview Independent Schools Fifth Third Bank First & Peoples Bank & Trust Co, First National Bank of Grayson General Sales Company Greenup County Schools Griffith Delaney Hillman & Lett Huntington Alloys Corporation JCPenney King's Daughters Medical Center Kelley Galloway Smith Goolsby Kentucky Farmers Bank Kroger Lawrence County Schools Louisville Gas & Electric / Kentucky Utilities Company Marathon Petr oleum Corporation Members Choice Credit Union Middough Consulting O'Reilly Auto Parts Pathways Peoples Bank Raceland-Worthington Independent Schools Raymond James Russell Independent Schools Safe Harbor Self Employed Smithfield Foods SWVA Kentucky LLC Three Rivers Medical Center TRC Global Mobility Tri State India Association Turner Industries Group UPS US Bank Walbridge Walmart Other Department: Other Employer I am interested in: I am interested in: Volunteer opportunities Community Investment panel member opportunity Verification Verification Sign above I verify that I have made the pledge above to the United Way of Northeast Kentucky for the 2023 campaign and authorize deductions or payments as indicated on this form.
