Points4UnitedWay Donation Form - United Way of Durham Region

Gift Information

Field Is Required Select Monthly Gift Amount:

$10.00

$25.00

$60.00

Other

Enter amount

Gift type:

One-time gift

Recurring gift

Select a Monthly Gift Duration:

Yes, make this an anonymous gift.

Name as you would like it to appear in the fundraising honor roll (e.g. John Smith, Anonymous, etc):

Yes, you can display the amount of my donation publicly

Personal Note (only visible by the fundraiser):

Honor/Memorial Information

Yes, this is an honor or memorial gift

Honor Gift Type:

Honoree First Name:

Honoree Last Name:

Your First Name:

Your Last Name:

Would you like to send an email notification? Yes, I would like to send an email notification.

Send email notification on:Select month of credit card Select Expiration Year

Recipient email addresses (separated by commas):

Stationary:

Subject Line:

Personal Message:

Yes, send me a copy of this email notification.

Billing Information

Title:

First Name:

Middle Name:

Last Name:

Suffix:

Street Address:

Apt/Box/Unit/Suite:

City:

Province/State:

Postal Code/ZIP:

Country:

Email Address:

Yes, I would like to receive emails updating me on the Points4UnitedWay campaign and other email announcements from United Way Durham Region.

Remember Me

Payment Information

Credit Card Information:

Credit Card Type:

Credit Card Number:

Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

Yes, I want 100% to go to United Way of Durham Region. Please increase my amount by 3% to cover today's, and if a recurring option is chosen, all future credit card transaction fees.

Please note that the option to add the transaction processing fee to your gift will apply to your gift today and all future monthly gifts.

Main Office: 345 Simcoe St. S., Oshawa, ON L1H 4J2
(905) 436-7377 | Map to our location | rhoward@unitedwaydr.com

The United Way of Durham Region is committed to protecting the privacy and confidentiality of personal information. The information provided may be used to assist in the proper administration and acknowledgement of gifts, to issue tax receipts and to fulfill information requests. For complete details of the privacy policy, please go to the UWDR website, www.unitedwaydr.com.