Preferred Donation Method Options - Select One - Select -Payroll Deduction Check Cash Debit/Credit Amount of Check Check Number Please take your check donation to your organization's designated United Way representative and make checks payable to: Griffin-Spalding County United Way or GSC United Way. Complete the rest of this form to register with your organization's campaign. Pledge Levels Dollars in Action 1 dollars a week = Almost a week of shelter for a victim of domestic violence 2 dollars a week = 5 Red Cross cleanup kits for families in disaster situations 4 dollars a week = Over two weeks of food delivers for a home bound senior citizen $1 a pay period $2 a pay period $4 a pay period Other… Enter other… Amount of Cash Please take your cash donation to your organization's designated United Way representative. Complete the rest of this form to register with your organization's campaign. When you complete this form you will be given a link to our secured processor so you can complete your online payment. Employer Location - Select -Griffin Plant Other School/Department Employee Number My Contact Information First Name Last Name Home Address City State - None -Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Zip Code Email Address Office Phone Cell Phone Donor Notes Donor Notes CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Submit Proceed to Payment Page Leave this field blank
