Lee County Clerk of Courts | United Way of Lee, Hendry, and Glades

United Way Campaign

Name as per your Social Security card:*

First

Last

ID Number from badge front:*

E-mail:*

To see a list of United Way Partner Agencies Please follow this link: Partner Agencies

Payroll Deduction - I hereby start or change my prior contribution by the following amount per pay period beginning December 21, 2024, or soonest pay period thereafter when I submit this form. I understand that payroll deductions will continue until changed or canceled by me:

Amount

$3 per pay period

$5 per pay period

$10 per pay period ($10+ enters you into the United Way 2-year lease car drawing)

$20 per pay period (Sextant Club)

$40 per pay period (Keel Club)

Other per pay period

If you are making a one-time gift payable by personal check or cash, please print this form and return along with the check or cash, to Kevin Karnes via interoffice mail or regular mail. Please make checks payable to United Way. Clerk Karnes can be reached at kkarnes@leeclerk.org or 239-533-2559

ONE TIME CREDIT CARD GIFT. We use PayPal. You do not need to have a PayPal account to use this option. Due to the fees for this option, the minimum amount is $26.

USD

I combine my gift with my spouse/partner. Please include their gift with mine. Enter name of spouse/partner and workplace.

United Way 211 administers the Clerk of Courts Employee Resource Program. If you would like a percentage of your gift to go to that program please indicate below:

10%

25%

Special Notes or Designations:

I hereby cancel my current United Way payroll deduction, effective the next pay period.

yes

UNITED WAY OF LEE, HENDRY, GLADES, AND OKEECHOBEE, INC. IS A 501(C)(3) NONPROFIT CORPORATION REGISTERED PURSUANT TO CHAPTER 496, SECTION 496.405 OF THE FLORIDA STATUTES. A COPY OF THE OFFICIAL REGISTRATION (CH31) AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (1-800-435-7352) WITHIN THE STATE OR FROM ITS WEBSITE AT WWW.800HELPFLA.COM. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE. EIN# 59-1005169

BY SUBMITTING THIS FORM, I AUTHORIZE THIS PLEDGE ACTIVITY AND UNDERSTAND IT WILL CONTINUE UNTIL I CANCEL OR CHANGE IT.

Address

2-1-1 HELPLINE

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