Thank you for your support of the United Way of Franklin County,Inc.

Name:_________________________ Phone:________________________

Address: ___________________________ City/Town: ____________ State: ___ Zip: ________

Company (if applicable):_________________________________

Your Email Address:_______________________________________

YOUR CONTRIBUTION

Your Donation:__________      Enclosed:__________ Balance: ___________

Bill me:  Annually ____ Quarterly ____ Monthly ____ Beginning on _________________

Charge my Visa or Master Card  (Please circle one)

Card #:_______________________

Expiration Date:_________     Signature:________________________________________

Your gift of $1,000 / year (just $20/week) qualifies you to be a Leadership Giver A gift of $500 / year (only $10/week) qualifies you to become a member of the Cornerstone Club.

Thank you!

Please mail to:

United Way of Franklin County, Inc.

51 Davis Street, Suite 2

Greenfield, MA 01301 ~ 413/772-2168