Employee Giving - Payroll Deduction Increase

Your Information

First Name*

Last Name*

Employee ID*

Department*

Work Address*

Work Phone*

Cell/Home Phone*

Email*

I wish to have my gift remain anonymous.

Payroll Deduction Amount

I authorize the following deduction from my paycheck:

New amount per paycheck $*

Fine Print

My payroll deduction is a recurring gift, and as such, I can increase, decrease, or stop at any time. My contribution will be automatically deducted from my paycheck beginning within 30 days of receipt of this form and will continue until such time as I request in writing that my recurring gift be stopped. Your gift is tax deductible.

Agreement

AGREEMENT: By signing this Electronic Signature Acknowledgment Form, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding. By signing below, I accept the conditions of this agreement.

I accept*

Signature (First and Last Name)*

Appeal Code: ECO

Cedars-Sinai Employee Giving Program

Payroll Deduction Form - Increase Donation Amount

Employee Payroll Deduction