Employee Giving Form

You can use the below form to sign up for payroll deduction gifts of Empower Hour PTO Club hour(s) (one-time or recurring).

Other giving options:

Questions that require an answer are marked with  *
   
* First Name
   
   
* Last Name
   
   
* Employee #
   
   
Phone Type
   
   
Phone Number
   
   
* Email
   
   
Payroll Donation

Gift Designation:
   
Other:
   
* Payroll Donations
   
   
One-time PTO Hour(s) Gift (*Must have minimum of 80 hours in PTO account)
   
   
Recurring PTO Hour(s) Gift (*Must have minimum of 80 hours in PTO account)
   
   
Recurring
   
Other:
   
One-Time
   
Other:
   
Recurring Gift

I understand that my recurring gift will continue at this amount until I request a change or cancellation.
   
   
Person who encouraged or inspired me to Give for Good:
   
   
* Signature (type your name in the box below)
   
   
* Today's Date
   
 Choose a date
   
* By Checking ‘I Accept’ you are agreeing to all terms and conditions that have been provided.