Foundation Payroll Deduction Agreement

METRO TECH CENTERS EMPLOYEE

PAYROLL DEDUCTION AGREEMENT
EMPLOYEE*
SITE*
I am a:*

NEW payroll deduction donor.CURRENT payroll deduction donor.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I would like to donate the amount checked below each pay period as a tax-deductible donation to the Metro Tech Foundation:

$2$5$10$20$30$50Other
I would like to INCREASE my current donation by the amount checked below each pay period as a tax-deductible donation to the Metro Tech Foundation:

$2$5$10$20$30$50Other
Employee Signature Please sign manually*

Clear
Date*

MonthDayYear
Date
If you have any questions, please feel free to contact Matt Wade, matt.wade@metrotech.edu

This deduction may be amended or discontinued at any time by written request by the employee.
Should be Empty:

METRO TECH CENTERS EMPLOYEE