TToottaall PPlleeddggee$ ____________

Amount Enclosed$ ____________

Pledge Balance$ ____________

_____________________________________________________________________________________Authorized Representative Title_____________________________________________________________________________________Organization/Business_____________________________________________________________________________________Address City State Zip_____________________________________________________________________________________E-mail Phone Fax_____________________________________________________________________________________Signature Date

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� Send Invoice

� Monthly � Quarterly � One Time __________ (month)

� Charge our credit card

Acct # _____________________________________ Exp ___________Please charge on ___________________ (date)

� Check Enclosed (please make check payable to United Way of Weld County)

United Way of Weld County Cornerstone Partners pay administrative and fundraising costs so that 100% of donations, designated to theCommunity Care Fund and/or one of our five action areas, go directly to needed programs and services in our community. Cornerstone

Partners are recognized in newspaper ads, on our website at www.unitedway-weld.org, in print publications and at award programs.

� Our organization does not wish to be a Cornerstone Partner. I understand that a 15% administrative fee will be deducted.

PO Box 1944 | Greeley, CO, 80632 | 970-353-4300 | Fax 970-353-4738 | www.unitedway-weld.org | uwwc@unitedway-weld.org

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Phelps-Tointon Inc. Quad/Graphics Roche Constructors, Inc. Wells Fargo

104.7 FM Pirate RadioAtmos EnergyBig R Bridge

Colorado Premium FoodsFarmers Bank - Ault

Professional Finance Company, Inc.

RR Donnelley Norwest, IncVestas Blades America, Inc.

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� YYEESS,, we want to be a Cornerstone Partner � Please provide us with more information aboutbecoming a Cornerstone Partner

� This is an In Kind Gift � In Kind Agreement Attached

Xcel Energy