myBurg - 2020 Fac/Staff Giving - Payroll Deduction

2022 Fac/Staff Giving - Payroll Deduction

2022-23 Faculty and Staff Payroll Deduction Form

First Name: Required Field

Last Name: Required Field

E-mail:

ID #

Please indicate your wishes for payroll deduction in 2023, including any you currently have that you would like to continue. This form provides space for you to enter payroll deductions for gifts to six different areas (designations). If you are setting up a payroll deduction for a single designation you will only need to fill out the fields under the "Gift 1" header.

Please enter the amounts you would like deducted per pay period.

Gift 1

Amount to be deducted for designation 1 (per pay period):

Designation 1

Gift 2

Amount to be deducted for designation 2 (per pay period):

Designation 2

Gift 3

Amount to be deducted for designation 3 (per pay period):

Designation 3

Gift 4

Amount to be deducted for designation 4 (per pay period):

Designation 4

Gift 5

Amount to be deducted for designation 5 (per pay period):

Designation 5

Gift 6

Amount to be deducted for designation 6 (per pay period):

Designation 6

Frequency of Payroll Deduction Gift Required Field

Frequency of Payroll Deduction Gift Continue monthly until further notice
Monthly for 2024 (12 months)
Other (specify below)

Total amount to be deducted from paycheck per pay period: Required Field

Other Instructions

No payment is required at this time. Automatic deductions will begin in January unless otherwise specified.

If you have questions about this form or your previous giving, please contact Bethany Brooks at bethany.brooks@wartburg.edu or 319-352-8513.

Please review your responses above prior to submitting.

This is a Blueprint template.