Campaign Information & Order Form

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

Fax Number

Campaign Start Date

Campaign End Date

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

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.

Will you need a copy of the United Way Campaign Video?

Would you like for a representative to speak during an employee meeting?

Date

Time

Maximum Time Allotment i.e. 10 (mins.) 20 (mins.), etc.

Item & Quantity (1)

Item & Quantity (2)

Item & Quantity (3)

Any additional comments.

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