A Gift Made “In Honor Of”

OR “In Memory Of”

Thank you for making a gift to the Callaway County United Way in honor of a family member, client, co-worker, teacher or friend.  Or a gift made in memory of a loved one.  Please complete this form and send along with your check or credit card information to the address above.  We will notify the honoree or family members of your gift to the Callaway County United Way. 

Type of gift:   

□         In honor of:

            Name of Honoree____________________________________________________

            Reason for honor____________________________________________________        

□       In memory of:

            Name of deceased___________________________________________________

            Name and Address of family member____________________________________

                                                __________________________________________________

Your Information:

Name___________________________________________________________________

Address_________________________________________________________________

City, State, Zip____________________________________________________________

Phone_______________________________Email_______________________________

Amount of gift:

□       I would like the amount of my gift disclosed to the honoree or family members

□       I would NOT like the amount of my gift disclosed to the honoree or family members

Payment Method:          □Cash       □Check      □Credit Card (Visa or MasterCard)

Make checks payable to:  Callaway County United Way

Credit Card Information:

Name on Card_____________________________________________________

Card Number____________________________________________________

Expiration Date_____________________________________________________