Donation Form

Your donation to United Way provides results in Broome County. Results that matter!
To donate, print out this form, fill it out, and mail it to:

United Way of Broome County
P.O. Box 550
Binghamton, NY  13902-0550

Date__________________

Name________________________________________________________________

Mailing Address________________________________________________________

City___________________________________State___________ZIP_____________

I would like my gift credited to:

Company____________________________________________

Amount of Gift $_______________

Method of Payment:

_____Cash

_____Check

_____VISA or MasterCard (circle one)

Dollar amount to be charged:___________________

Card Number_______________________________________

Expiration Date______________________

Signature_____________________________________________________________________________

Thank you for making a difference in so many lives!

United Way of Broome County P.O. Box 550 Binghamton, NY 13902-0550 Voice: (607) 729-2592 Fax: (607) 729-2597 e-mail: info@uwbroome.org entire site copyright 2008 United Way of Broome County

Inspiring hope for a better tomorrow