Thank you for your interest in donating to the United Way of the Valley and the Greater Utica Area. Please fill out this form to receive bills by mail for your pledge amount.

Name:

Employer:

Street Address:

City:

State:

Zip:

Phone Number:

Email Address:

DIRECT BILLING INFORMATION

Total Pledge:

$ over $25.00

Please Bill Me:

Annually Semi-Annually Quarterly Monthly

Preferred Billing Address: (if different from above)

City:

State:

Zip:

Comments:

This pledge will be included with your company’s total pledge.