United Way of Monongalia and Preston Counties Logo
Entry Fee
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Group Entry Fee
$750
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$75
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Donation Amount
$
Contact information
Company/Team Name
Number of Employees
First Name
Last Name
Mobile Number
Email
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Zip
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Team Captain(s) (If different)
Team Captain Email Address
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Account Number
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Account Type
checking
savings
Name on Account
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Card Number
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3-Digit Card Verification Number
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4-Digit Card Verification Number
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CVV
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What is this?
I would like to cover the payment processing fee.
Donor hereby approves the payment of the donation and/or purchase to United Way of Monongalia and Preston Counties and in the amount set forth herein.
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