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Please Bill Me:*

Start Date: *

Salutation: * Mr Ms Mrs

First Name:* (as shown on the credit card)

Last Name:* (as shown on the credit card)

Address:* (credit card billing address)

City:*

State:*

Country:*

Zip Code:*

Email:*

Company:

Telephone #:*

Fax #:

Have you remembered AUW in your will? If so we'd like to thank you! Yes No

Please send me information on AUW's endowment program. Yes No

Please send me information about giving stock. Yes No

If you wish to designate all or a portion of your gift, please fill out the section below.

Note: Please ensure that the total gifts designated is less than or equal to your total donation amount to avoid processing errors.

Click here for the complete Aloha United Way 2011 Donor Designation List for your reference.

Donation Amount: $

Focus my gift in one or more of the following areas:

A. Aloha United Way Community Care Fund what is this?	$
211 Information and Referral Services what is this?	$
Volunteer Hawaii/Gifts-in-Kind what is this?	$

B. Impact Areas

Crime and Drug Use what is this?	$
Early Childhood Development what is this?	$
Emergency and Crisis Services what is this?	$
Financial Stability and Independence what is this?	$
Homelessness what is this?	$

C. Agency/Program Support ($48 MINIMUM PER CHOICE)

My gift is designated to one or more specific agencies or programs. Processing fee may apply.

Note: To avoid any processing error of this transaction, please make sure that both agency name and amount are entered.

Amount: $

TOTAL GIFT(S) DESIGNATED (A-C)
(Must not exceed donation amount) $