Pledge Card


Preferred Contribution Method

Please make check payment to: 'United Way of Long Island' and include in the memo section on your check ‘Workplace’; Send your check and completed pledge to your HR rep./Campaign Captain.

Credit Card Donors:

Thank you for your support of United Way of Long Island.
To complete your conribution by credit card please click HERE.

Payroll Deduction

I want to contribute the following amount each pay period via payroll deduction.

I receive a paycheck...
Cash Contributions

Send cash contribution and completed pledge form and return to your HR rep./Campaign Captain.

Your Name
Your Contact Information
Invest My Contribution In...

Choose your designation(s) from the list below by typing the percentage of your total contribution you would like allocated. Percentages must total 100%.

Please type the name of your designated 501(c)(3) community partner agency here. For a list of United Way of Long Island’s community partner agencies visit
All payroll deductions are continuous from year-to year unless otherwise directed by you. Gifts designated to a specific community partner agency must be made annually by donors. All undesignated gifts will revert to the Long Island Impact Fund.

My signature below, confirms my payroll deduction request as stated above.

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