Employee Giving Modification Form

Employee Giving

Payroll Deduction Modification Form
I would like to modify or cancel my recurring payroll deduction donation to Life Unlimited.

(Update the amount, designation, or cancel)
Name*

First NameLast Name
Email*
example@example.com
Update the amount or designation of my weekly donation from my recurring payroll deduction.Cancel my recurring donation.
$20$10$5$2Other
I would like for my new donations to support*
I authorize Life Unlimited, Inc. to deduct the amount indicated above from my weekly paycheck to serve as a charitable donation in support of Life Unlimited's mission. This authorization replaces my previous recurring employee giving agreement. This authorization is effective the first full pay period following submission of this form and for all future pay periods during my employ until I submit a subsequent request to modify or cancel (form available on the employee giving page), or until termination of my employment.
I request that Life Unlimited cancel my existing employee giving agreement and stop my recurring payroll deduction donations, effective the first full pay period following submission of this form.

I understand that I am free to sign up for recurring donations via payroll deduction again in the future by submitting the Employee Giving Payroll Deduction Authorization Form found on the Employee Giving page of Life Unlimited's website.
Signature*
Date*

MonthDayYear
Date
Should be Empty:

Employee Giving