Christmas 2021 - Food Bank Donation by Payroll Deduction

Food Bank Donation Via Payroll Deduction

Please complete and submit this form only if you wish to make a personal donation to the food bank this Christmas season. The money will be deducted directly from your pay cheque on the pay period indicated.

Your Name(Required)

Email(Required)

(To send a copy of your selections.)

Which Pay Period Would You Like The Direct Payroll Deduction to be Made?

December 15th, 2021

December 31st, 2021

$ Amount to Deduct December 15

$ Amount to Deduct December 31

Consent for Direct Payroll Deduction

I agree to allow Primco HR to make a Direct Payroll Deduction in accordance with the choices I've made above. I understand any tax receipts will be issued directly by the Food Bank.

Would You Like a Tax Receipt for this Donation?(Required)

Yes

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)