Employee Payroll Deduction Form For The Missouri State Foundation printable pdf download

Employee Payroll Deduction Form for the Missouri State Foundation

(For deductions for a minimum of 9 months)

(Please print, complete and return to Assistant Director of Advancement Services, Office of

Development and Alumni Relations.)

Name: ________________________________________

Employee M#: ________________________

Home Address and Telephone #:

_____________________________________________________

Campus Dept./Office and Telephone #:

_____________________________________________________

I. Please check ONE of the boxes below relating to the information to be filled out in

Section II of this form:

_____ The deduction detailed in Section II is a new contribution to the Missouri State

Foundation and currently my only gift being made through the payroll deduction plan.

_____ I currently have a payroll deduction to the Missouri State Foundation each

month. Please continue this deduction per the original paperwork I filled out regarding this

gift.

_____ I currently have a payroll deduction to the Missouri State Foundation each

month. Please discontinue this contribution at this time.

_____ I currently have a payroll deduction to the Missouri State Foundation that I

wish to change at this time. I have filled out the information in Section II to reflect such

changes in the amount and/or designation of my current deduction so that the information

listed below reflects the TOTAL DOLLAR AMOUNT I WISH TO HAVE DEDUCTED FROM

MY CHECK EACH MONTH AS A GIFT TO THE MISSOURI STATE FOUNDATION.

II. I would like to make a monthly gift to the Missouri State Foundation through payroll

deduction in the amount of $____________ per month beginning with my

___________________ (indicate month and year) paycheck and ending with my

______________ paycheck. This gift should be designated for (indicate account/area)

_____________________________.

If you do not indicate in Section II a month and year for beginning and/or ending this

deduction, your gift will begin in the next pay period following receipt of this form and will

continue until you inform Payroll in writing that you wish this deduction to cease.

If you are splitting your monthly gift between more than one area of designation, please

clearly delineate in Section II the dollar portion of your total gift which goes to each

account/area each month.

Signature:________________________________________ Date: _________________

Employee Payroll Deduction Form For The Missouri State Foundation