Anti-Terrorism Compliance Measures
In compliance with the USA Patriot Act and other counterterrorism laws, the
United Way of West Alabama requires that each agency certify the following:
“I hereby certify on behalf of
_______________________________________________
(Name of Grantee)
that all United Way funds and donations will be used in compliance with all
applicable Anti-terrorist financing and asset control laws, statues and executive
orders.”
Print Name: ____________________________ Title:
____________________________
Signature: _____________________________ Date:
____________________________
Federal Identification Number:
_____________________________________________
501 (c) (3)
Yes _____________
No _____________
Please return this form to: United Way of West Alabama, Inc.
Attn: Holly Beck
P O Box 2291
Tuscaloosa, AL 35403
Or Email PDF Version:
holly@uwwa.org
Or Fax to:
(205) 345-6681