United Way

Name

Prefix:

First:

Middle:

Last:

Suffix:

Gender

Birth Date

Main Address

Address Line 1:

Address Line 2:

City:

State:

ZIP/Postal Code:

Country:

Cell Phone - Individuals

Area:

Number:

Extension:

Items marked with an asterisk (*) are required

I,II,III,IV,V,Jr.,Sr.,M.D.,Ph.D.,D.O.,C.F.A.,C.F.R.E.,C.P.A.,D.D.S.,D.M.D.,Ed.D.,Esq.,M.A.,M.B.A.,M.S.,M.S.W.,P.E.,R.N.,VI,

What type of gift is this?

In Memory

In Honor

What is the name of the individual this gift is in Memory/Honor of?

Would you like a Gift Notification sent to the family (gift amounts will not be disclosed)?

Yes

* Recipient's Name:

Contribution recognition will be sent via email if provided; if not provide, recognition will be send via traditional mail.

Recipient's Address:

Recipient's Email Address:

Items marked with an asterisk(*) are required

Credit Card

Paypal

Your charge will be $

Total Pledge Amount

Your Donation Amount

Please enter your donation amount:

Your invoice will be $

Total Pledge Amount

Billing Start Date:

Billing Frequency:

Monthly

Quarterly

Once

In addition to your online donation, please fill out the form located here and mail it to your broker.

Please also send a copy to:
Sonja Simonson
c/o United Way of Southwestern Pennsylvania
1250 Penn Avenue PO Box 735
Pittsburgh, PA 15230
Or email your completed form to sonja.simonson@unitedwayswpa.org

Total Pledge Amount

Reminder Start Date:

Total Pledge Amount

Payment Start Date:

Payment Frequency:

Today

Monthly

Quarterly

Once

Total Pledge Amount

Payment Frequency:

Total Pledge Amount

Payment Method:

Credit Card

Total Pledge Amount

Payment Method:

Paypal

Join now. Your generous leadership level contribution makes you and your partner eligible for Women's United, a dynamic group of more than 2,300 women who believe in the collective power of women and empowering each other to accomplish more together.

Join now. Your generous leadership level contribution makes you and your partner eligible for Bridges Society, a powerful group of early to mid-careers individuals who want to make connections and give back with purpose.

Go paperless - get statement by email only

Create Account Information

Please select your pledge type

Your Donation Amount

Give to ensure a bright future for everyone

Thank You!