Contribute to United Way!

Thank you for supporting the United Way of Midland. Your donation will make a difference in our community!

Contribution Amount

$ 25.00

$ 50.00

$ 75.00

$ 100.00

$ 250.00

$ 500.00

Leadership Level - $ 1,000.00

Other Amount

Other Amount $

Total Amount

Name and Address

First Name *

Last Name *

Mobile Phone

Street Address (Home)

City (Home)

State (Home)

Postal Code (Home)

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

First Name *

Middle Name

Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Please list company name below if donating through workplace.

Company Name

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