Faculty/Staff Voluntary Payroll Deduction Form for
Tax Deductible Donations to the EOU Foundation
_______________________ ______________________ ________ ____________________
Last Name First Name MI EOU Payroll #
Home Mailing Address
Amount of Monthly Deduction:
Select one of the following choices:
1. Number of months
(Specify the number of months that you want the deduction to be
processed. The deduction will automatically stop at the end of the
specified number of months.)
Total amt. contributed:
End date for deduction:__________
X ________________
2. Continuous deduction
(The deduction will continue from year
to year until you contact UA or the
EOU Payroll Office and request the
deduction to be
Please use my gift for:
Unrestricted needs
Restrict for _________________________________________
_____________________________________ _______________________
Signature of Donor Date
Thank you for giving to the EOU Foundation. If you have any questions, please call 541-962-
Complete top portion of form & return directly to University Advancement, IH 212B.
Last updated 12/02/14 Office Use:
UA Office: Rec’d___________ Processed by___________ Sent to Payroll___________ Enter into RE________
Payroll Office: Beginning___________ Ending____________ Plan Type__________ Date_______
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