|
Summary: PAYROLL DEDUCTION
Your monthly pledge will be deducted from the first payroll
of each month. (Minimum annual deduction is $24 or $2
each month over 12 months.)
$________________ X 12 PAY PERIODS = $ ______________
$________________ X 9 PAY PERIODS = $ ______________
TOTAL AMOUNT OF PLEDGE _________________________
PAYROLL AUTHORIZATION
I voluntarily authorize the above monthly deduction from
my after-tax wages for a charitable contribution as indicated
above. I understand this authorization automatically expires
after 9 or 12 pay periods. I also understand that I may
revoke this authorization at any time by giving my payroll
office written notice.
SIGNATURE
DATE
CREDIT CARD
You may make a secure on-line gift at
https://giving.uh.edu/uhgivesback/
I have made an on-line gift of $_____________________
|
