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 Year20192020202120222023 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Campaign End Date Year Year20192020202120222023 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 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 * Will you need a copy of the United Way Campaign Video? * YESNO 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? * YESNOUNDECIDED Date Year Year201920202021202220232024 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Time Hour Hour123456789101112 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm Maximum Time Allotment i.e. 10 (mins.) 20 (mins.), etc. Item & Quantity (1) Item & Quantity (2) Item & Quantity (3) Any additional comments. Leave this field blank CAPTCHAThis question is for testing whether you are a human visitor and to prevent automated spam submissions. View the discussion thread.