Campaign Information & Order Form

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 *

Year

Month

Day

Campaign End Date

Year

Month

Day

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, ACC schedule 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 *

Will you need a copy of the United Way Campaign Video? *

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.

Would you like for a representative to speak during an employee meeting? *

Date

Year

Month

Day

Time

Hour

Minute

Maximum Time Allotment i.e. 10 (mins.) 20 (mins.), etc.

Item & Quantity (1)

Item & Quantity (2)

Item & Quantity (3)

Any additional comments.

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