Yes! I want to make a gift to the United Fund of LaGrange County, Inc.

This year I’d like to give:
___$50 ___$75 ___$100 $_______ (other)

(Please note Leadership Giving starts at $250.)

I’d like to make my gift using:

___One personal check, enclosed.
___Please bill me. (Circle one)
Quarterly Semi-annually Monthly Other_____________

Name: _______________________________________________
Address: _____________________________________________
City: ________________________________________________
State: _______________________ Zip Code: _______________

Telephone # Home (___) _________________
Telephone # Business (___)_________________
E-mail Address:______________@___________
Company Name: __________________________

Signature:___________________________________________________
(This information allows us to acknowledge corporate campaign participation)

THANK YOU FOR YOUR SUPPORT!

Please mail to: United Fund of LaGrange County
P.O. Box 203
LaGrange, IN 4676