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United Way Donation Form


United Way brings people and resources together to create positive change and lasting impact in our community.

United Way will never release or sell donor information.

*indicates a required field

My Personal Information

Full Name*:
Home Address*:
City*:
State*:
Zip*:
Home Phone:
Preferred Email (for e-newsletters):
LOYAL CONTRIBUTORS
I have donated to UW for:
10-24 Years
25+ Years

My United Way Pledge

Payroll deductions will be based on 26 pay periods.

Amount of payroll deduction (per pay period)*:
If Other, please type in the amount here (per pay period): $
Total Pledged Amount*: $
Please choose the market you want your donation to benefit.:
Yes, I am a Pillar! (Gift of $500 or more)
Name of Spouse/Significant Other:
Employer:
List my/our name in the Pillar Book as follows:
Do you want my/our name published?:
Yes
No

My Community Investment

Please choose where you would like your donation invested.

COMMUNITY IMPACT FUND: The most powerful way to impact lives in your county:

Focus my Community Impact Fund gift to one or more Community Goals
Education:
Health & Well-Being:
Financial Stability:

Specific Charitable Organization ($100 minimum):
Name of the charitable organization:
Amount: $
Do you want your name released to the designated agency in connection with this gift?:
Yes
No

I authorize First Busey Corporation to deduct the above amount via payroll deduction.
Name*:
Date*:
Within 1-2 business days, you will receive an email confirmation of your donation.