Donations Welcome | Ada Regional United Way

#StartTodayUnited

I want to contribute this amount every

Donor Information

First Name *

Middle Name

Last Name *

Street Address *

City *

State *

Zip Code *

Email *

Phone *

Donor Recognition

I have been giving to United way for ___ years (Years of giving do not have to be continuous)

I authorize my name to be recognized *

Yes, I wish to be recognized.

No, I wish to remain anonymous.

I would like my gift to be "In Honor" of someone.

Yes No

Inidividual's Full Name

Please describe what this gift is "In Honor" of:

Birthday, Christmas, Memorial, etc.

Would you like for the individual to recevie acknowledgement of your gift?

Yes No

If yes, please provide the individuals mailing address.

City, State & Zip code