Thank you for giving to your favorite charity through the CFD. Your current monthly payroll deducon(s) will roll over into the
new year unless changed. New/updated payroll deducons 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 submied. If you have quesons,
feel free to contact us at the CFD state oce, (360) 902-4162.
Please sign and return this form to your workplace
CFD volunteer or to the CFD state oce at:
PO Box 40250, Olympia, WA 98504 (Mail Stop #40250)
New Donor Change My Current Donaon(s) Add To My Current Donaon(s) Cancel My Donaon(s)
Name (Last, First, MI) Employee ID #
Agency/Campus Agency/Campus Code County of Work
Email Work Phone
Charity Name Charity Code
Monthly Payroll
Donaon
One-me
Payroll Donaon
Donaon
by Check
CFD Non-Specied Fund 0316854
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
Please completely ll in the informaon below. (Clearly Print)
Fill in your donaon informaon. Please make donaons by check payable to the Combined Fund Drive.
By signing this form I understand that once started, my monthly payroll deducon will connue automacally unless changed by either compleng a new Contribuon Form,
updang my donaon account online at www.cfd.wa.gov, canceled by checking the cancel box or by wrien noce to the CFD oce. In signing this form I acknowledge that my
donaon(s) will be updated per the guidelines and informaon provided above. I hereby authorize the State of Washington to deduct the amount indicated from my pay provided
that the amount deducted will be remied on a regular basis in support of the charies of the Washington State Combined Fund Drive as specied above.
Please Sign and Date
X Date
(your signature is required to process your donaon)
I wish to donate
anonymously
CONTRIBUTION FORM
Go Paperless
Manage your account, search for charies and keep
up on all things CFD by vising our website today.
www.cfd.wa.gov
