LIVE UNITED

Thank you for supporting the Town of Palm Beach United Way. Your donation will make a difference in our community.

Contribution Amount

$ 5,000.00

$ 1,000.00

$ 500.00

$ 100.00

$ 50.00

$ 25.00

Other Amount

Other Amount $

Total Amount

I want to contribute this amount every every

Personal Information

Title

First Name *

Last Name *

Email Address *

Street Address *

City *

State *

Postal Code *

Country

Company

Phone

Please publish my/our name(s) as *

I was referred by

This gift is in honor of

This gift is in memory of

Memo

Credit Card

Card Type

Card Number

Security Code

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

THE TOWN OF PALM BEACH UNITED WAY MEETS ALL REQUIREMENTS SPECIFIED BY THE FLORIDA SOLICITATION OF CONTRIBUTIONS ACT. A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL FREE WITHIN THE STATE (1-800-435-7352). REGISTRATION DOES NOT IMPLY ENDORESEMENT, APPROVAL OR RECOMMENDATIONS BY THE STATE. FLORIDA REGISTRATION NUMBER 710843, FEDERAL ID NUMBER 59-063-7885. THE TOWN OF PALM BEACH UNITED WAY RECEIVES 100% OF EACH CONTRIBUTION. THIS INFORMATION WILL BE USED ONLY BY THE TOWN OF PALM BEACH UNITED WAY AND WILL NOT BE DISCLOSED TO OTHER PARTIES.