Benedict College Faculty and Staff Payroll Deduction Form

Check one of the following:
- Faculty/Staff
- BC Alumni - Faculty/Staff
Class Year
Name*
Prefix First Last
Department*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email
Please specify how you would like your donation/pledge distributed below:
BC Annual Giving
Annual Giving
Athletics
Charter Day
Endowed Scholarship
Please select the Endowed Scholarship you wish to donate to
Other Endowed Scholarship which is not listed (please specify)
Other
UNCF
United Way
Other
If Other, please specify
Restricted for
Total
$0.00
My donation will be paid by:*
- Cash
- Check
- Payroll Deduction
- Credit Card
Please start my payroll deduction as of*
MM slash DD slash YYYY
Please deduct this amount per pay period:*
Please continue my payroll deduction:*
- until donation/pledge amount has been reached.
- indefintely. I will notify HR to discontinue deductions.
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Signature
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BC Annual Giving