Employee Giving form

Fletcher Employee Giving Pledge Form
Employee Email
example@example.com
How would you like to donate?
Per Pay Period
I hereby authorize my employer to deduct a total of $ Amount* per pay period, from my salary until further notice and remit same to Fletcher Technical Community College Foundation as tax-deduction contribution in support for the Falcon Nest Egg.
I would prefer my donation to be used for:Reason
One Time Contribution
I wish to make a single tax-deduction to the Fletcher Technical Community College Foundation in the amount of $ Amount* . This will be a one-time only contribution, not a reduction from my payroll in support of the Falcon Nest Egg.
I would prefer my donation be used for: Reason
Cash or Check payable to: Fletcher Technical Community College Foundation
I would like my name to appear in the annual report as:
Please complete the form and return it to beth.hall@fletcher or office 117. Fletcher Foundation will turn in paperwork to the Human Resources Department for their records as well.

Please sign below to authorize your payroll deduction pledge in accordance with standards for any other authorized payroll deductions. I hereby waive on behalf of myself, my heirs, successors, agents, and assigns any and all rights of action against the State of Louisiana, its agents, and assigns, arising out of the deduction, failure to deduct, or any other handling of this request for payroll withholding.
Changing your pledge?
Printed Name
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Fletcher Employee Giving Pledge Form

Per Pay Period

One Time Contribution