Company Name Please indicate your company's mailing address? Mailing Address City, State Zip Code Official website CEO/President/Manager's Name Phone Number Email Address Campaign Coordinator Name Phone Email Fax Number Campaign Start Date Campaign End Date Continuing efforts towards maintaining accurate records, please indicate the total number of employees within your company. Participation percentages, per capita gifts, campaign awards and other significant items will be based on the number that is provided below. Total Employees Each employee packet includes a United Way brochure, pledge form, discount prescription card, NC 2-1-1 info and Car Giveaway flyer. Please indicate how many employee packets you will need. Employee Packets Also, indicate the number of additional items needed for your campaign below. Promotional Posters Goal Posters Our Campaign Advocates including volunteers and Agency representatives are willing to come to speak to your employees on how United Way is improving the lives of local citizens through collaborative efforts. Will you need a copy of the United Way Campaign Video? - Select -YES NO Would you like for a representative to speak during an employee meeting? - Select -YES NO UNDECIDED Date Time Maximum Time Allotment i.e. 10 (mins.) 20 (mins.), etc. Item & Quantity (1) Item & Quantity (2) Item & Quantity (3) Any additional comments. CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Submit
