Please fill out the Request Form at least 10 business days prior to your campaign kick-off date to allow for set-up and testing.�

1)Company Name *

2)Company Campaign Manager Name: *

3)Email Address: *

4)Would you like any employees to have adminstrative rights to your e-Pledge site?

Yes

First & Last Name

Include employee pledge amounts

Do NOT include employee pledge amounts (only responses)

Add Additional Person.

First Name

Include employee pledge amounts

Do NOT include employee pledge amounts (only responses)

5)Total Number of pay periods: *

6)Can employees change the number of pay periods for their payroll deduction gift (not to exceed the total number)?

Yes

7)Date Campaign kick-off email will be sent: *

8)Use one of our internal email addresses to send our email messages to employees at our organization.

Yes

Organization's CEO

Organization's Company Campaign Manager

Other

9)Name of sender: *

10)Email address to send our communications from: *

Your kick-off email will be sent from unitedway@unitedwaymc.org.

11)Dates you would like reminder emails sent:

12)What date would you like your e-pledge site to close? *

13)Submitted by (email address): *

You will receive a follow up email from Nancy Czerwinski to coordinate messages for your emails.

Items marked with an asterisk(*) are required

Customer Service Hours: Monday - Friday, 8 AM - 5 PM
help@unitedwaymc.org

United Way
of Marathon County
705 S 24th Ave, Ste 400B
Wausau, WI 54401
715-848-2927