WHC Pledge Form – United Way of Acadiana

WHC Employee Payroll Deduction Form

Fill out the form below to pledge for a payroll deduction through United Way of Acadiana

About You

Name(Required)

First Last

Phone(Required)

Birthdate(Required)

Email(Required)

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Payroll Deduction Information

I get paid....(Required)

Weekly

Bi-weekly

Twice a Month

Monthly

Other

If other, please fill out here.

I want to donate....(Required)

70% of your donation will be placed into the WHC Cares Fund, and 30% to United Way of Acadiana.

If other, ($___ amount per check) please fill out amount here.(Required)

If you would like to specifically designate your donation to a 501(c)(3) nonprofit organization in your local community, please input name here.

Information must be included to process designation. You may select one organization per $100 donation. Incorrect entries benefit Untied Way of Acadiana. Administration fees apply. Please provide full address of your designation.

Consent

Type Name Here(Required)