Employee Name
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| I authorize my payroll deduction gift as follows: |
Amount per pay period (24 pay periods per year)
| Total Annual Gift
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| I choose to make a one time contribution. | One Time Contribution Amount
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Organization Name
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Total Amount Designated from Above
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Please acknowledge my gift (if this box is not checked, your donation will be considered anonymous) |
Employee Email (Please complete only if you would like your e-mail address released to the organization(s) you have designated.)
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Thank You!
All gifts are tax deductible to the full extent provided by law. No goods or services are provided to you in consideration of your contribution. |