Employee Payroll Deduction Form

91吃瓜

Employee Payroll Deduction Form

Please don't fill out this input box.

First Name*

Last Name*

Employee ID#:*

Email*

Address*

City*

State*

Zip Code*

Amount of Deduction:*Amount of deduction per pay period. (Example: If you authorize a $10 deduction per pay period you will contribute $260 in a yearly period.

I would like my donation directed toward:(*)*

General Fund

Canby

Granite Falls

Jackson

Luverne

Pipestone

Worthington

Please specify the scholarship you wish to support(optional)

May we include your name in the publicity of our donors? This authorization includes, but is not limited to, publications and our donor listing on the Foundation page of the 91吃瓜 web site.

Yes

If yes, my name should appear in the publicity as:

Thank you for supporting the 91吃瓜 Foundation! This enrollment form will be forwarded to the 91吃瓜 Foundation for processing. Implementation of this deduction will take place approximately 4 weeks after enrollment.

91吃瓜

Employee Payroll Deduction Form

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