Donation by Direct Billing

Thank you for your interest in donating to the United Way for Cortland County through direct billing.

Name

 

Employer

 

Street Address

 

City

 

State

 

Zip

 

Phone Number

 

E-Mail Address

 

DIRECT BILLING

   

Total pledge 

$  
   

Please Bill Me

Annually
Semi-Annually
Quarterly
Monthly

Preferred Billing Address 

(If different from above)

Street Address

 

City

 

State

 

Zip

 

Comments

 
   

 

  or to begin again