Name *Choose a County (Check All That Apply): RocklandBergenOrangePassaicPutnamSullivanSussexWestchesterOtherIf Other: Please choose only one: I will keep my donation the same as last year (you do not need to complete any other part of this form - click submit)I am a new donor or I will be making changes from last year's donationAmount of Donation Community Impact Percentage Allocated across United Way programs to make the most positive impact in the areas of education, financial stability and healthDonation Acknowledgement Requested YesNoSpecific Charity Percentage Name of Charity (Optional) Donation Frequency: One-Time Payroll DonationOne-Time Credit Card Donation (After Form Submit, Complete Payment Via Link Provided)CheckWeekly Payroll DeductionBi-Monthly Payroll DeductionGeneral Comments EmailSubmit
