ANNUAL GIVING
PAYROLL DEDUCTION FORM
Office of Development
Shelbie King Hall, 3rd Floor
256-824-2105
Please complete, sign, and send to Lisa Bevis - Shelbie King Hall, Room 316.
I authorize the university to deduct
$
Please note that date of first deduction will be determined by payroll processing deadlines.
Designate my contribution as follows:
(Name of scholarship)
I authorize the UAH Payroll Department to deduct my gift as specified above.
Name: Department:
Address:
Phone: Email:
Signature: Date:
Gift receipts are issued annually in January for tax purposes.
Revised 5/2016
per pay period for a total pledge of
$
OR
I authorize the university to deduct
$
continuously until I notify the Office of Development in writing.
President's Excellence Fund
Scholarship - _________________________________________________________________________________
Other - ______________________________________________________________________________________
Office of Development
Comments: ____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
