Campaign Summary Report

Current Account Information
Gifts, Pledges, & Other Contributions
Total Raised
Delivery Preference
Campaign Summary Report

This form can be completed in place of the previous campaign envelope. If you submit this form, you will not need to complete the envelope.

If you have any questions while completing this form, don't hesitate to connect with Niki Tripodi, Vice President Resource & Development

352-732-9696 ext. 205 | ntripodi@uwmc.org

Account Name

Individual or Organization

Your Contact Information

Name

Department

Phone

Has the address on this account changed since your last campaign?

Yes

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

THE LATEST

Solicitation Disclaimer A COPY OF THE OFFICIAL REGISTRATION (CH214) AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES AT www.fdacs.gov/consumerservices OR BY CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.

Agency Donation Disclaimer It is the policy of United Way of Marion County to deduct 14.25% for fundraising, pledge processing, and uncollectable costs from designated contributions to affiliated and unaffiliated agencies. All agencies must provide evidence of compliance with the Patriot Act in order to receive any designated contribution(s).

Donor Privacy United Way of Marion County uses donor information only to confirm gifts, send information on how gifts are invested, and for accurate tracking. We do not share individual donor information (unless requested to do so by the donor) or sell donor information. Names printed in the United Way of Marion County recognition materials are a matter of public record. If you do not want your name to appear, please indicate on this form that you wish to remain anonymous.

Tax Deduction Notice Your gift is tax-deductible. Please follow the IRS Tax Guidelines. Taxpayers who wish to deduct contributions made through payroll deduction must retain a pay stub, Form W-2, or other documents furnished by the employer that shows the total amount withheld for payment to charity, along with the pledge card.

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Campaign Summary Report