United Way of St. Francois County Pledge Form

614 Wal-Mart Drive, PMB #172
Farmington, MO 63640

Name_______________________________________________________________________

Address_____________________________________________________________________

City/State/Zip_________________________________________________________________

Phone Number___________________________Email Address__________________________


                 I/we pledge $________ to the United Way of St. Francois County.

□ Cash or Check (enclosed)     □ I would like to be billed

□ By credit card (please choose)   □ One Time   □ Monthly   □ Quarterly

□ Visa    □ Mastercard

Card #__________________________________________ Expiration date_______________

Signature__________________________________


Your United Way contribution is an investment in our community - Thank you!

No goods or services were provided in consideration for this contribution; therefore, the full amount of your  United Way donation qualifies as a tax deduction. 

If you make a gift of $250 or more a federal tax provision requires that you obtain a receipt, which United Way will send in January.