365 Small Business Circle | United Way of South Central Massachusetts

365 SMALL BUSINESS CIRCLE FORM

Your Information

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Address

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Select 365 Small Business Circle Level

365 Small Business Circle Levels

365 Partner ($1 a day, $365/yr)

365 Plus Partner ($2 a day, $740/yr)

365 Leader ($1,000 or more)

365 Partner $

365 Plus Partner $

365 Leader $

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I am interested in Volunteer Opportunities

I'm interested in Committees & Board Involvement

I am interested in Planned Giving/Bequests

Please keep my donation anonymous

Payment Method

Select 365 Small Business Circle Level

Check

Bill Me

Credit/Debit Card

Check Donation

Amount of Check $

Make checks payable to United Way of South Central Massachutes and mail to:
176 Main St., Suite 400, Southbridge, MA 01550

Bill Me

Select Bill Me Option

One Time

Monthly

Quarterly

One Time Bill Me Amount $

Monthly Amount to be Billed $

Quarterly Amount to be Billed $

Credit/Debit Card Donation

Select One

One Time Donation

Monthly Recurring Donation

Amount of your One Time Donation $

Amount donated each month $

After completing this form you will be redirected to our payment page where you will be able to process your transaction in a secured environment. Please be sure to enter the same values that you have entered on this form. Thank you!

Total Annual Contribution

TOTAL: $0

Agreement

My signature below, confirms what I have provided on this form to be accurate.

Signature

Thank you for your contribution. United Way of SCM acknowledges no goods or services beyond what is listed is provided to the company. Your gift is tax deductible to the fullest extent of the law. Please keep a copy of this form for your tax records. Consult your tax advisor for more information.