UC Impact Payroll Deduction

Payroll Deduction
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Appeal Name
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Please make my gift In Tribute Of/In Memory Of
Add Another Donation?
Enter Donation Amount Here
Select an Area to Support
Enter Designation Here
Please make my gift In Tribute Of/In Memory Of
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Gifts of $15 or more, through November 30, are eligible for the #GivingTuesday promotion, would you like to receive the limited-edition 2021 Bearcat ornament?
Donor Information
Employee ID#
Primary Employer
Title
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address Type
Phone Number

Area CodePhone Number
Phone Type
Permission to Publish
If you were referred by a UC Day of Giving Ambassador, please enter their name

First NameLast Name
Payroll Deduction Information
Deducted Amount per Pay Period
Ex. $50
Number of Pay Periods
Total Gift Amount
Pay Period in which to start deductions
Pay-Period
Signature
By typing your name in the Signature block, you are authorizing your pledge.
Should be Empty:

Payroll Deduction