United Way

United Way of El Paso County Logo

Contact information

First Name

Last Name

Department

KRONOS or Employee ID Number

Mobile Number

Address

City

State

Zip

Birth Year

Contribution

Check off the amount of your payroll allotment, cash or check contribution. Enter in the total of your contribution in the space provided.

I WANT TO PAY THE EASY WAY-THROUGH PAYROLL DEDUCTION

I pledge ____ per 26 pay periods:

$2.00

$5.00

$10.00

$20.00

Other

Other Amount: $

Total Yearly Pledge: $

Please direct my gift or the indicated portion to the federation or agencies listed below.

(1) Four Digit Agency Code:

(1) Amount: $

(2) Four Digit Agency Code:

(2) Amount: $

(3) Four Digit Agency Code:

(3) Amount: $

(4) Four Digit Agency Code:

(4) Amount: $

(5) Four Digit Agency Code:

(5) Amount: $

The City of El Paso Employees Combined Charities Campaign does not provide goods or services in whole or partial consideration for contributions made to the campaign.

Please have the agency acknowledge my gift (Mailing address must be complete)

Payroll deduction authorization: I hereby authorize the City of El Paso to deduct the amount shown above from my pay each pay period during the calendar year 2022 starting with the first pay period that begins in January and ending with the last pay period that ends in December, and to pay the amount so deducted to the City of El Paso Employees Combined Charities Campaign shown above. I understand that this authorization can be revoked by me at any time before it expires. Requests for One-Time Deductions will be made in writing to be attached to this pledge form.