United Way of the Wabash Valley Logo
Small Business Circle Registration
Business Name
required
First Name
required
Last Name
required
Business Phone
required
Email
required
Business Address
required
City
required
State
required
Your State
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Zip
required
Donation Amount
$
Membership Level
Decrease quantity for Member
Enter quantity for Member
Increase quantity for Member
Member
$365
Decrease quantity for Partner
Enter quantity for Partner
Increase quantity for Partner
Partner
$1,095
Decrease quantity for Leader
Enter quantity for Leader
Increase quantity for Leader
Leader
$1,825
Your membership includes two tickets to a United Way event of your choice. Please let us know which event you'd like to attend.
required
Select Option
Annual Meeting (Feb.)
Power of the Community (Sept.)
Power of the Purse (Oct.)
I would like to know more about each event
Thank you, but I do not need any tickets
How would you like to pay?
required
Select Option
Credit Card
Email me an invoice
Mail me an invoice
I will send a check - I do not need an invoice
Payment Information
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Credit Card
Pay With
Apple Pay
This is a secure 256-bit SSL encrypted payment
Routing Number
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Account Number
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Account Type
checking
savings
Name on Account
OK
Card Number
required
required
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This field is required.
Expired Credit Card
Discover, Mastercard, Visa
3-Digit Card Verification Number
American Express
4-Digit Card Verification Number
OK
CVV
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I would like to cover the payment processing fee.
Donor hereby approves the payment of the donation and/or purchase to United Way of the Wabash Valley and in the amount set forth herein.
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