Belmont University Payroll Deduction Form

Belmont Payroll Deduction Form

To create or modify a payroll deduction pledge, please complete the following form.

If you wish to make a one-time contribution by credit card, please click here.

Questions? Please call the Office of Development at 615-460-6402 or email development@belmont.edu.

First Name:*

Last Name:*

BUID:*

Department:

Email:*

Phone Number:*

Area CodePhone Number

Employee Type:*

Ten-month employee paid over 10 monthsTen-month employee paid over 12 monthsTwelve-month employee paid over 12 months

Pay Schedule:*

Bi-WeeklyMonthly

Indicate if you are an adjunct:

YesNo

Amount to be deducted each pay period:*

If you would like to split your payroll deduction across multiple funds, please note details below:

CLEAR

Or, choose from designation options below:

Area of Support (See next box for fund list)

Gift Designation (Belmont Fund Program):

Gift Designation (College-based Support):

Gift Designation (Pathway Funds):

Gift Designation (Athletics):

Gift Designation (All):

Please contact Belmont University's Office of Development at (615) 460-5517 to discuss giving opportunities related to faculty support.

Other Gift Designation:

Start Date:*

New commitmentUpgrade existing commitmentKeep existing commitmentChange existing commitment

Your commitment may be cancelled or changed at any time by notifying the Office of Development in writing. If you wish to make alternate arrangements, please describe below.

SLCTRCRDT

We are grateful for your support. Thank you for all you do for Belmont!

Gift Designation

Payroll Deduction Details