Employee Pledge Form 2026 | Jackson County United Way

Name

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Company Name

Contact Preference

Leadership Giving Level

Payroll Deduction Amount

Pay Periods

Special Requests / Notes

T-Shirt Size

Those who pledge to give $5 or more per paycheck or $130 or more per year qualify for a free T-shirt.

NOTE: Companies must have 10 or more gifts of $5 or more for an order to be placed.

I would like my gift to remain anonymous.

I would like to learn more about volunteer opportunities at Jackson County United Way.

I give my employer permission to release my employment status to Jackson County United Way if I leave the company so they (JCUW) can contact me about my outstanding pledge.