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  • individual
  • company

Update Individual Contact Info form

NAME - First: MI: Last:
Employer:
Work Phone:
Home Phone:
Home Address (line 1):
Home Address (line 2):
City:
State:
Zip:
E-mail Address:

Update Company Contact Info form

  Company Info:
Name:
Address (line 1):
Address (line 2):
City:
State:
Zip:
Phone:
Fax:
Website/Company URL:
Total Number of Employees:
  CEO/Local Executive:
NAME - First: MI: Last:
Phone:
E-mail:
  Campaign Coordinator:
NAME - First: MI: Last:
Phone:
E-mail:
  Payroll Contact:
NAME - First: MI: Last:
Phone:
E-mail:
  Leadership Giving Coordinator:
NAME - First: MI: Last:
Phone:
E-mail:
  Other info: (If applicable)
Branch Location:
Union name:
(If any of your work force is represented by Organized Labor, please
provide the name of that Union.)
Any other changes:
  Form Completed By:
NAME - First: MI: Last:
Date:

 

United Way of Southwestern Indiana / P.O. Box 18, Evansville, Indiana 47701-0018
Ph. 812-422-4100, Fax. 812-421-7474

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