PLEASE COMPLETE AND RETURN
ORIGINAL FORM TO:
Attention: Jessica Wells
Development and Alumni Relations
Dengerink Administration Building, Room 203
360-546-9600, jessica.r.wells@wsu.edu
GIFT INFORMATION
VERY IMPORTANT
Select either “Indenite” OR “Until this amount is reached.” (Select ONE only)
INDEFINITE OR
UNTIL THIS AMOUNT
IS REACHED
(See note below*)
ANONYMOUS?
OFFICE USE ONLY
PLEDGE #
AMOUNT PER PAYCHECK
$__________________
AREA OR FUND NAME/ACCT #
n
OR
$__________________
n
YES
AMOUNT PER PAYCHECK
$__________________
AREA OR FUND NAME/ACCT #
n
OR
$__________________
n
YES
AMOUNT PER PAYCHECK
$__________________
AREA OR FUND NAME/ACCT #
n
OR
$__________________
n
YES
AMOUNT PER PAYCHECK
$__________________
AREA OR FUND NAME/ACCT #
n
OR
$__________________
n
YES
AMOUNT PER PAYCHECK
$__________________
AREA OR FUND NAME/ACCT #
n
OR
$__________________
n
YES
AMOUNT PER PAYCHECK
$__________________
AREA OR FUND NAME/ACCT #
n
OR
$__________________
n
YES
*If you choose this option, deductions end when the specied amount is reached.
TOTAL DEDUCTION AND DONOR SIGNATURE
I authorize the WSU Foundation to take a total of $____________________________ from each paycheck (twice monthly). Begin this deduction on the
paycheck dated_____________. I understand that this authorization remains in eect until cancelled in writing or committment has been reached. I
understand that my payroll deduction may only be deposited to an account to which I do not hold signature authority and under conditions where
there is no personal benet to me arising from the tax deductible nature of this charitable gift.
SIGNATURE DATE
ANNUAL GIFT LEVELS
Annual gift levels are based on accumulative giving during a fiscal year (July June). Annual Gift Clubs are as follows:
PAYROLL DEDUCTION GIFT RECEIPTS
Your gift may be tax deductible as a charitable contribution. Contact your tax advisor for further information. The WSU Foundation prepares gift
receipts for all payroll deduction gifts on a calendar year basis (January December) for donor tax purposes. You should recieve your receipt no
later than January 31.
Give today. Inspire tomorrow.
EMPLOYE E GIVING PROGRAM
WSU AG 6/2016
RETAIN A COPY FOR YOUR RECORDS. FOR QUESTIONS, OR TO CANCEL YOUR DEDUCTION, CONTACT THE WSU FOUNDATION AT 509-335-1686.
SUSTAINING PRESIDENT’S ASSOCIATE CRIMSON PRESIDENT’S ASSOCIATE
$1–$499.99 $2,500–$4,999.99 $10,000–$49,999.99
($.01–$20.83 per paycheck) ($104.17–$208.33 per paycheck) ($416.67–2,083.33 per paycheck)
TOWER CLUB SILVER PRESIDENT’S ASSOCIATE PLATINUM PRESIDENT’S ASSOCIATE
$500–$999.99 $5,000–$9,999.99 $50,000 or more
($20.84–$41.66 per paycheck) ($208.34–$416.66 per paycheck) ($2,083.34+ per paycheck)
BRYAN SOCIETY
$1,000–$2,499.99
($41.67–$104.16 per paycheck)
GIFT PAYROLL DEDUCTION
DATE_________/_________/_________
WSU ID# ______________________________________ NAME ____________________________________________________ EMAIL ___________________________________________________________
DEPARTMENT ____________________________________________________________ MAIL CODE ___________________ WORK TELEPHONE ____________________________________________
Faculty & Staff Giving Campaign
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