FORM GPC 14
Personal Pledge Form
Please strengthen the Power of Partnership™ and
improve lives by completing the information below
2014 - 2015
1. Personal Information
320 East Gutierrez St
Santa Barbara, CA 93101
tel 805.965.8591
fax 805.962.3461
www.unitedwaysb.org
name: title, first, middle, last, suffix
employer name
department and job title
zip code
work address
home address
ca
/
state
city
(
)
-
zip code
(
work/daytime telephone
/
birthday (year optional)
)
-
M
home telephone
F
gender
email address
Please contact me about:
Newsletter/e-News
Volunteer Opportunities
Thank-You Report
Endowment/Gift Planning
2. How I prefer to Give
A. EASY PAYROLL DEDUCTION (24 pay-periods/yr)
2. Increase my Current Pledge
per pay period by:
1. I would like to continuously pledge the following amount
each pay period: (choose one)
$417
Alexis de Tocqueville Society.
$100
$10
$ 50
United Way’s Leadership Circle.
$20
$5
$ 25
United Way’s President’s Club.
$10
$2
$ 16
Matches the Community Average Gift 2013.
$ 13
Young Leaders Society (ages 40 and under).
Other: $
Other: $
B. CREDIT/DEBIT CARD PLEDGE - Frequency Preference for Charging Credit Card:
each gift
start date
m m- d d - y y :
$
my total annual gift
times/yr
x
,
= $
Charge my Mastercard, Visa, American Express, Discover:
Card #
C.
3
D.
,
Exp. Date: m m - y y
my total annual gift
Cash/Check gift (enclosed)
(Check payable to United Way of Santa Barbara County)
$
,
Stock Pledge
Contact U.W. Finance Director at 965.8591 x124 with security and broker name
3. My Signature
Date
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Annual Restricted Giving
OPTIONAL: choose any of the following categories below:
Amount:
*Any gift under $115 per restricted gift per year will be considered a gift to United Way.
(Total below)
A GEOGRAPHIC AREA/SPECIFIC CHARITY*
Restrict my gift to (charity or community):
Address:
City/State/Zip:
$
,
$
,
B UNITED WAY OF SANTA BARBARA COUNTY FUND (Code 91501)
UWSBC Fund supports over 75 programs and partnerships changing the
lives of local children, families, and seniors in need. We use the Power
of Partnership™ to connect the best resources of Santa Barbara County
and make the greatest long-term impact on pressing needs.
C
C AREAS OF IMPACT
Successful Children & Youth (Code 91598)
Ensuring all children enter school ready to learn
$
$
,
,
Health (Code 732)
Improving health; healthcare coverage, prevention
Strong Families (Code 91600)
Promoting loving and supportive families
$
$
,
Independent Seniors (Code 91599)
Greater independence for seniors and their caregivers
$
,
5
Education (Code 733)
Helping children and youth achieve their potential
,
Financial Stability (Code 739)
Promoting financial stability and independence
$
,
Leadership Recognition
Young Leaders Society (YLS) Community oriented individuals or couples 40
years of age or younger, contributing a combined annual gift of $300 or more
may become members of the Young Leaders Society of Santa Barbara County.
United Way Community All Stars (CAS) Individuals who have contributed a net
of $500 or more undesignated to United Way of Santa Barbara County for three
or more consecutive years.
Leadership Circle United Way of Santa Barbara County’s Leadership Circle
provides a crucial base of support for sustaining current services and reaching
unmet areas of need. We thank our Leadership Circle members for their
important role by name in our major publications. May qualify for United Way
Community All Stars.
My name will appear as listed on reverse side.
Leadership Level
Total Annual Gift
YLS Member
$300 or more
CAS
$500 or more
Bronze Member
Silver Member
Gold Member
Tocqueville Society
$1,200-$2,999
$3,000-$5,999
$6,000-$9,999
$10,000 or more
Please list my/our name(s) as follows:
I prefer that my gift remain anonymous.
United Way of Santa Barbara County | 320 East Gutierrez Street, Santa Barbara, CA 93101 | phone 965-8591 | fax 962-3461
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