Payroll Deduction Form

Please complete and submit the information below to authorize the Madison College Foundation to set up a payroll deduction on your behalf.

Gift type*
Name*
First Last
Employee ID*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Enter Yearly Amount*
This deduction will terminate at the end of the following calendar year unless auto-renew is selected. If you select more than one designation, we will automatically evenly distribute unless notified.
I would like my pledge to auto renew.*
- Yes
- No
Gift Designation*
- Best Use
- Adopt a Scholar/Scholars of Promise
- Smart Future Scholarship
- Give to an Existing Scholarship
- Other
Enter Scholarship Name
Enter Other Designation
Notes
Please Check to Confirm*
- I authorize Madison College Foundation to set up this payment on my behalf.
Signature (type your full name)*