Fillable 2017CSA Payroll DeductionWG2 (Lower Columbia College)

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2017CSA Payroll DeductionWG2 (Lower Columbia College)

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LCC Authorization for Payroll Deduction
Fresh Picked Produce!!
Enroll Stop Change
Willow Grove Gardens brings their Community Supported Agriculture Program to LCC. Fresh
produce will be delivered every Thursday from June 15 to October 26.
Employee Name:
EID#
Date:
Full Share-$20/week:
Half Share-$10/week:
Please list any special requests:
Please check the Thursdays you will be on vacation and do not want to receive a share:
June 15 June 22 June 29 July 6 July 13 July 20
July 27 Aug 3 Aug 10 Aug 17 Aug 24 Aug 31
Sept 7 Sept 14 Sept 21 Sept 28 Oct 5 Oct 12
Oct 19 Oct 26
I authorize LCC to deduct a maximum of $40 for a full share or $20 for a half share per pay
period over 10 pay periods (6/26/17-11/09/17) in order to participate in the Community
Supported Agriculture Program.
Signature:
Date:
For HR/Payroll
# of weeks: ________ Total Amount to Deduct:_________
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2017CSA Payroll DeductionWG2 (Lower Columbia College)

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Completed 25 July 2020

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