2019 Knox County Employees Consolidated Charities Campaign Pledge Form
Name: Emp. # Department
Step One:
Choose your payment method.
Option 1 Payroll Deduction: I authorize $_______________ per paycheck for 26 paychecks totaling $______________ year.
Option 2 One-Time Gift: I am enclosing my total gift of $_________________ (Cash) or $ ____________________ (Check)
Step Two:
Designate your gift — amount per pay check or attached cash/check
Enter Agency Code # on line below — if applicable Enter ($) Amount below
Agency # Agency Name__________________________ $
Agency # Agency Name___________________________ $
United Way of Greater Knoxville ………………………………………..............$
***Agiftofatleast$100.00onaseparateUnitedWayformisneededtodesignatetoaspecific
UnitedWayAgency.Formsavailable
online
Agency # Agency Name__________________________ $
Agency # Agency Name__________________________ $
Total Designation Amount $ per check x 26 = $ _____________ yearly (Must match amount in Step 1)
Signature (Required) Date ___________________
Step Three:
Complete save and send to anthony.smith@knoxcounty.org or fax 215-3242
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2019 Knox County Employees Consolidated Charities Campaign Pledge Receipt—PLEASE CUT OFF AND KEEP FOR TAX PURPOSES
Name: Amount: $ _________________ Date:
*
**(SheriffDept.Employees—KnoxCountyEMP#isrequired—“PleasedonotuseyourBadge#”)***
click to sign
signature
click to edit
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