Westminster Employee Donation by Payroll Deduction Form

Name*

First Name

Last Name

Phone*

Email*

Department*

Where do you want your donation to go?*

Westminster Fund

Other:

Type of Deduction*

Ongoing Payroll Deduction Specific Pledge Amount One-Time Payroll Deduction

Ongoing Payroll Deduction

This contribution will continue until you request that it stop or change by contacting the Office of Institutional Advancement.

New Deduction Amount per Pay Period* $

New Deduction Start Date*

Total Gift Amount Pledged* $

Number of Pay Periods to be Deducted From*

Deduction Start Date*

Deduction Amount* $

Deduction Date*

Additional Comments