Make Your Pledge

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Make Your Pledge

Please complete this form to designate a gift using payroll deductions to the annual United Way of La Porte County Community Investment Campaign. For questions about payroll deductions, please contact Dave Sisk at dave@unitedwaylpc.org or (219) 210-3534.

Email *

Title *

First Name *

Middle Name or Initial

Last Name *

Home Address *

House number and street name. i.e. 422 Franklin St.

Home Address City *

Home Address State *

Home Address Zip Code *

Cell Phone Number

Home Phone Number

Company Name *

Department

If applicable

How often are you paid? *

How much do you want to contribute from each paycheck? *

Please consider 1 hour's pay per month, 1% of your total income, or an increase over last year's gift.

Would you like to designate your gift?

Designate my gift where the need is greatest

I would like to designate my gift to a specific agency

I would like to designate my gift to another United Way

Clear selection

Retiring soon? If so, please provide us your retirement date, so we can send a Direct Mail donation form to the home address provided above following your retirement.

YYYY

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