PBA Payroll Pledge Form
Personal Information
Name:
*
First Name
Last Name
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email:
*
example@example.com
Thank you for giving to PBA through payroll deduction! When you complete this form, the Office of Advancement will collaborate with Human Resources to implement the deduction from your paycheck within 1-2 pay periods. First, choose how many funds you’d like to give toward. You can select one, such as God-Sized Dreams Campaign, or more, such as Annual Fund. If you select more than one fund, you’ll need to complete “Payroll Information” for all fund designations. Next, complete your personal and contact information and fill out the Payroll Information section, including the amount you’d like to give per paycheck, your start date and duration, and chosen gift fund. If you have any questions, please contact Lisa Aaron at lisa_aaron@pba.edu or 561-803-2007.
How many funds would you like to support?
*
Please Select
1
2
3
Payroll Information
Designation #1
PBA ID#:
*
Deduction amount per paycheck:
*
Start Date: (please allow one pay period to pass from your submission date):
*
-
Month
-
Day
Year
Date
Duration: (If "other" please enter end date)
*
Recurring (max 3 years)
Other
Gift Fund: (ex. God-Sized Dreams Campaign, Annual Fund, etc.)
*
*
By checking this box, I consent for a payroll deduction to be set up in my name using the information above.
Additional Comments:
Designation #2
PBA ID#:
*
Deduction amount per paycheck:
*
Start Date: (please allow one pay period to pass from your submission date):
*
-
Month
-
Day
Year
Date
Duration: (If "other" please enter end date)
*
Recurring (max 3 years)
Other
Gift Fund: (ex. God-Sized Dreams Campaign, Annual Fund, etc.)
*
*
By checking this box, I consent for a payroll deduction to be set up in my name using the information above.
Additional Comments:
Designation #3
PBA ID#:
*
Deduction amount per paycheck:
*
Start Date: (please allow one pay period to pass from your submission date):
*
-
Month
-
Day
Year
Date
Duration: (If "other" please enter end date)
*
Recurring (max 3 years)
Other
Gift Fund: (ex. God-Sized Dreams Campaign, Annual Fund, etc.)
*
*
By checking this box, I consent for a payroll deduction to be set up in my name using the information above.
Additional Comments:
Total
*
Submit
Should be Empty: