Fill out this form to donate funds through payroll deduction(s) to the United Way. A receipt will be delivered to your department in January and your payroll deduction(s) will begin with the 1/08/14 paycheck.
Please provide the following information to help us best serve you.
Payroll Deduction - Per Pay Period $ (NOTE: Annual donation will be this amount x 26 PPs) Enter Per Pay Period Number only (no additional notes or characters)
One Time Payroll Deduction (Numeric entry only)
PDO Deduction - You must have a balance of at least 96 PDO hours in order to be eligible to donate PDO hours. A request that brings your PDO balance below 96 hours will not be processed. Enter the number of hours you would like to donate. (Numeric entry only)
Option B - Designated Gift ($100.00/yr minimum) I want my gift to go to a specific charity that United Way supports. List Name of Agency(s) and amount to go to each agency.