Colleague Giving Campaign

Gift Information*

Please designate your gift.

My Gift is*

(Deductions begin July 1, 2018, and will go through June 30, 2019)

How Much Is Your One-Time Gift? $

How Much Is Your Gift? $

How much is 1% of your salary?

Annual Pay x 0.01 ÷ 26 pays

When you make an ongoing gift, your gift continues until you tell us otherwise. You do not need to fill out a new pledge form yearly, unless you want to make a change in your pledge.

How Much Will Your Ongoing Payroll Deduction Be? $

How Much Will Your Ongoing Credit Card Payment Be? $

Credit Card

Name

First Name

Initial (optional)

Last Name

Home Address

Address Line 1

Address Line 2

City

State

ZIP Code

Colleague ID*

Department*

Worksite*

What is your worksite?

Are You Paid Through Mount Carmel?

Yes No

Are You Paid Through Trinity?

Yes No

Email

e-Signature*

I Accept

By selecting the "I Accept" button, you are signing this donation form electronically. You agree your electronic signature is the legal equivalent of your manual signature. By selecting "I Accept" you consent to be legally and financially bound by this agreement's terms and conditions.