Thank you for giving to your favorite charity through the CFD. Your current monthly payroll deducon(s) will roll over into the
new year unless changed. New/updated payroll deducons will be processed at the rst possible pay period unless otherwise
instructed by the donor. Checks will be processed immediately regardless of when this form is submied. If you have quesons,
feel free to contact us at the CFD state oce, (360) 902-4162.
Please sign and return this form to your workplace
CFD volunteer or to the CFD state oce at:
PO Box 40250, Olympia, WA 98504 (Mail Stop #40250)
New Donor Change My Current Donaon(s) Add To My Current Donaon(s) Cancel My Donaon(s)
Name (Last, First, MI) Employee ID #
Agency/Campus Agency/Campus Code County of Work
Email Work Phone
Charity Name Charity Code
Monthly Payroll
Donaon
One-me
Payroll Donaon
Donaon
by Check
CFD Non-Specied Fund 0316854
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
Please completely ll in the informaon below. (Clearly Print)
Fill in your donaon informaon. Please make donaons by check payable to the Combined Fund Drive.
By signing this form I understand that once started, my monthly payroll deducon will connue automacally unless changed by either compleng a new Contribuon Form,
updang my donaon account online at www.cfd.wa.gov, canceled by checking the cancel box or by wrien noce to the CFD oce. In signing this form I acknowledge that my
donaon(s) will be updated per the guidelines and informaon provided above. I hereby authorize the State of Washington to deduct the amount indicated from my pay provided
that the amount deducted will be remied on a regular basis in support of the charies of the Washington State Combined Fund Drive as specied above.
Please Sign and Date
X Date
(your signature is required to process your donaon)
I wish to donate
anonymously
CONTRIBUTION FORM
Go Paperless
Manage your account, search for charies and keep
up on all things CFD by vising our website today.
www.cfd.wa.gov