Payroll Deduction Form

Please fill out our secure form below to set up your donations directly from your workplace payroll. This information will only be shared with your company in order to complete payroll deduction set-up.

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* First Name

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* Last Name

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* Email Address

Burke County United Way collects contact information in order to thank donors and and provide them with a tax receipt.

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* Phone Number

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* Mailing Address

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* I want to contribute the following amount per pay period:

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* Number of pay periods:

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* My total gift amount is:
(Amount  x  Number of Pay Periods)

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* Designate your gift:

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