2011 RETIREE Annual Giving Campaign Donation Form
By submitting this form you are choosing to participate in the Intel Community Giving Campaign and consenting to the transfer of data to United Way. Intel assumes no liability in the event of a data breach at United Way.
LAST NAME
FIRST NAME
Address
City,
State,
Zip
Phone number
e-mail address
World Wide ID# (If Known)
Retired from which site? ____AZ ____CO ___FM ____MA ___NM ___OR ___ SC ___WA Other_______________________
[ ] I would like to make a total annual gift amount of : $_________
SELECT PAYMENT TYPE FOR MY GIFT
1) Check made payable to United Way (attach in sealed envelope)
2) Charge my credit/debit card:
[ ] one-time [ ] monthly [ ] quarterly [ ] semi-annual
Billing Start Date:__________________________________
Card Type
Card Number
Exp. /
Name on card: ________________________________________________
Please choose one or more of the following options:
[ ] I want my gift to support my local United Way Community Fund.
County State Zip Code
____________________________________________________________________
[ ] I want my gift to support my favorite non-profit organization(s) with 501(c)3 tax exempt status. Each organization/agency will receive 100% of the dollars designated. To give to more than 3 organizations, please attach additional sheets. Make check payable to United Way.
1) Agency Name
Address
City
State
Non Profit 501(C3) number if known ________________
2) Agency Name
Address
City
State
Non Profit 501(C3) number if known ________________
3) Agency Name
Address
City
State
Non Profit 501(C3) number if known ________________
……………………………………………………………..
[ ] I would like to make a donation of stock (Additional forms required) A campaign representative will contact you to facilitate the stock transfer once the donation form has been received. (Please contact Renee Levin if you have questions)
Stock Name ________________________________
# of shares _________
Current estimated stock price (total amount) $______________
……………………………………………………..
Acknowledgement – MY CHOICE
1)I wish to receive an acknowledgement from UNITED WAY confirming my contribution.
2)I wish to release my name to MY DESIGNATED AGENCY(S) in order to receive acknowledgement of my contribution.
3)I wish to remain anonymous in United Way’s recognition materials
Thank you for your generous donation. Please make a copy for your records. United Way does not provide goods or services in whole or partial consideration for any contributions made.
-
Return Completed Form to:
Intel Corporation
Attn: Renee Levin, CH7-301
5000 W Chandler Blvd.
Chandler, AZ 85226
In order for your donation to qualify for the Intel Foundation Matching Gift, we must receive this form by November 4,2011.
% of total gift to be applied to each non-profit you have designated.
_______%
_______%
_______%
_______%
Retiree Signature:
Date: