UA15.Section.Giving. Employee Giving. Payroll Deduction (Form) - Lewis University

Employee Payroll Deduction Form

Payroll Deduction Form

First Name*

Last Name*

Employee ID #*

Total Pledge Commitment

Gift amount per pay period*

Designation #1*

Designation Amount #1*

Designation #2

Designation #2 Amount

Start Date*

End Date

Continuing until further notice

End by:

If end date option is selected, specify end date:

Please type YES in the box if you consent to this transaction*

QUESTIONS:

Would you like information regarding your giving history? Or your current payroll deduction? Contact Krysten McGee at kmcgee2@lewisu.edu or 815-836-5966.

LewisAlumni&Friends

Employee Payroll Deduction Form