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Payroll Deduction Form

Payroll Deduction Form
Please choose the amount per pay period you would like to donate.
    
If you checked other amount above, please designate the amount below.
(# of deductions)
Indicate total amount of gift.
PLEASE NOTIFY YOUR PAYROLL DEPARTMENT ABOUT YOUR GIFT. ALL EMPLOYEES MUST SET UP PAYROLL DEDUCTIONS THROUGH THEIR EMPLOYER'S PAYROLL DEPARTMENT.
By typing your name, you are verifying that all information provided is accurate.