Wabash County United Fund Donation Form Donor Name:* First Last Company Name: Cell Phone:*Email:* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Agency Designation (Optional):Use My Donation Where Needed85 HopeAdvantage Housing, Inc.Arc of Wabash CountyBlessings in a Backpack - North ManchesterBlessings in a Backpack - WabashCommunity Assistance Program (Lighthouse Mission)Community Cupboard Food PantryFamily Service Society/Hands of HopeHoosiers Feeding the HungryLearn More CenterManchester Early Learning CenterRoann Community FoundationSomerset Community BuildingThe Access Youth CenterUrbana Community BuildingVolunteer Income Tax AssistanceWabash County Cancer SocietyWabash County Tobacco Free CoalitionWabash County TransitWabash FAMEUnited Way/Fund:If you would like your donation to be designated to a different United Way/Fund, please indicate the organization name (or county name) here. Donation Amount:*$500$100$50$25OtherOther amount:* What type of credit card are you using for this donation?*-- Please Select --American ExpressDiscover CardMastercardVisaProcessing Fee Yes, I will cover the credit card processing fee. Processing Fee:* Price: $0.00 Processing Fee:* Price: $0.00 Processing Fee:* Price: $0.00 Processing Fee:* Price: $0.00 Total Donation: $0.00 Donation Frequency:*-- Please Select --One Time DonationMonthly DonationQuarterly DonationSemi-annual DonationAnnual DonationIf you select a recurring donation frequency (monthly, quarterly, semi-annually, annually) your initial donation will be processed as soon as you submit this form. Subsequent donations will be processed based on the option you selected. If you wish to end your recurring donation plan please contact us at firstname.lastname@example.org.Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.