Payroll Deduction Form

EMPLOYEE INFORMATION

Name:
Email:
Department:
Address:
City:
State:
Zip:
Phone:
Primary Affiliation:

Consider a pledge over the entire year to increase the impact of your gift. Even a small amount each pay period can have a huge impact on the life of a student!

$38.47 per pay for one year = $1,000

(President’s Club Membership)

$15 per pay for one year = $390

$10 per pay for one year = $260

$5 per pay for one year = $130

GIVING OPTIONS

I would like to make a one-time gift of $

I would like to pledge $ for number of pay period.

GIFT DESIGNATION

Other:

PAYMENT METHOD

I authorize payment through payroll deduction as specified.

ADDITIONAL INFORMATION:

Signature:
Date:
Questions? Please contact: annual giving, ext. x1241 or payroll, ext. x1380

SUBMIT

Walsh is accredited by the Higher Learning Commission ( www.hlcommission.org; phone: 312-263-0456). Specific degree programs are accredited by the Accreditation Council for Business Schools and Program (ACBSP, www.acbsp.org).
Administrative Offices are located at 3838 Livernois Rd, Troy, MI 48083. Additional locations in Michigan: Novi, Clinton Township, and Port Huron.

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