Bridge Builders Payroll Deduction

Lyon College Payroll Deduction
Name*

PrefixFirst NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email*
Email is required for confirmation.
Campus Component
Total Monthly Payroll Deduction Amount*
Indefinitely, until I request a changeSpecific end date
Deduction Start Date*

MonthDayYear
Date
Deduction End Date*

MonthDayYear
Date
Lyon College Annual FundBe the Change Textbook InitiativeLyon Athletics (general Athletics unless otherwise specified)Other
If "other", please specify
Gift in honor or memory of
Individual's name
Notes and Special Instructions
Thank you so much for supporting our wonderful college! If you have any questions or want to offer your thoughts and ideas for employee philanthropy, please contact Jill Mobley at extension 7226 or at Jill.Mobley@lyon.edu.
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Lyon College Payroll Deduction