Better Together Pledge Form |

Employee Information

Please fill out all sections. Please provide a mailing address so that we can send you a tax acknowledgement letter for your records.

Name*

First M.I. Last

Campus*

Home Address*

Street Address Address Line 2 City State ZIP Code

Email

Phone

Giving to Support Sun Health's Nonprofit Mission

Payroll deductions for this campaign will begin with the second paycheck received in January.

Payroll Deduction

$ 25 per pay period
$ 15 per pay period
$ 10 per pay period
$ 5 per pay period
Custom Amount
One time payroll deduction

Amount to contribute per pay period

One-time payroll deduction of:

Please enter a number greater than or equal to 10.

(minimum $10)

YES! Please automatically renew my pledge every year. You can cancel or update this at any time by contacting your HR representative.

Allocate 100% of your contribution to a single fund OR, using percentages, divide it among no more than 2 funds.
If no designation is indicated, your donation will be allocated to the General Fund for use in the areas of greatest need.

General Funds/Area of Greatest Need

*Team Member Emergency Fund (03AF)
Sun Health Foundation Greatest Need (03GE)
Other (please specify)

% to Team Member Emergency Fund (03AF)

Please enter a number from 0 to 100.

% to Sun Health Foundation Greatest Need (03GE)

Please enter a number from 0 to 100.

Allocate this %

Please enter a number from 0 to 100.

to

tell us how you'd like these funds used.

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Total %

Signature

For purposes of donor recognition, I prefer my gift to remain anonymous.