Current Start Preview Complete Donor Information First Name Last Name Home Address City State - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Email Address Phone Number This donation is in support of: The United Way General Fund The CHEW Program Other… What does this donation support? Credit Card Donation Would you be willing to cover the 3% online processing fee? Yes No Frequency of Your Donation One-Time Donation Recurring Donation (monthly) Recurring Donation (every 3 months) Recurring gifts will occur perpetually until you notify our office to stop payments. You may provide special instructions in the "Donor Notes" field below. One-Time Amount $10 $25 $50 $70 - For 70 Years of Giving $100 $250 $500 Other… Enter other… Monthly Recurring Amount $5/month ($5.15/month charged) $10/month ($10.30/month charged) $25/month ($25.75/month charged) $50/month ($51.50/month charged) $70/month ($72.10/month) - 70 Years of Giving $100/month ($103/month charged) $250/month ($257.50/month charged) Quarterly Recurring Amount $50/quarter ($51.50/quarter charged) $125/quarter ($128.75/quarter charged) $250/quarter ($257.50/quarter charged) $500/quarter ($515/quarter charged) $1000/quarter ($1030/quarter charged) $1,250/quarter ($1287.50/quarter charged) Frequency of Your Donation One-Time Donation Recurring Donation (monthly) Recurring Donation (every 3 months) Recurring gifts will occur perpetually until you notify our office to stop payments. You may provide special instructions in the "Donor Notes" field below. One-Time Amount $10 $25 $50 $70 - For 70 Years of Giving $100 $250 $500 Other… Enter other… Monthly Recurring Amount $5/month $10/month $25/month $50/month $70/month (70 Years of Giving) $100/month $250/month Quarterly Recurring Amount $50/quarter $125/quarter $250/quarter $500/quarter $1000/quarter $1,250/quarter Donor Notes Payment Information Leave this field blank