1. SSN, Employee
Name
Employees
should fill in name. Social security number is needed only
if direct deposit is chosen.
2. If you select
payroll deduction, choose the time period that matches your pay
schedule.
(2a)
Write in the amount that you wish deducted each pay period.
(2b) Write in the total that you want deducted for the year under
Annual Gift. Your pledge will be divided equally among your paychecks
starting in January 2005 and continuing through December 2005, if
you submit your pledge card by December 1, 2004.
3. Choose Cash,
Check, or Credit Card.
Write in the total amount of cash or check. If you are using a credit
card, circle the card used, write in your credit card number and
the expiration date, and the amount you wish to donate.
4. Designate your
favorite charity or charities.
Check the appropriate box to indicate whether or not you wish to
designate your gift to a specific charity. Choose up to four charities
on this form. Write in the specific code number, the annual amount
you wish to donate to that charity, and the name of the charity.
Refer to your CVC directory to identify code number. If you wish
to learn more about the charity, you can access the state's CVC
homepage at http://www.cvc.vipnet.org/
.
5. Authorize your
contribution.
Sign and date your pledge card. This is mandatory for payroll deductions
and credit cards.
6. Acknowledge
your contribution.
If you wish to receive an acknowledgement from the charity or charities
to which you designated money, check "YES" and provide your complete
mailing address. Please request an acknowledgement, as charities
that receive donations want to know the names of their donors. Otherwise
check "NO."
7. Return the pledge
card to the campaign volunteer in your area.
Return the pledge card to your Campaign Associate in the Human Resources
Department or volunteer in your area.
8. Keep the pink
bottom copy of the pledge card for your records.
Keep the pink (bottom) copy of the pledge card for your records.
Campaign
Progress
Campaign Volunteers 