PAYROLL DEDUCTION CONTRIBUTION AGREEMENT
Employee Information (All fields are required.)
Name (Last, First, MI) _______________________________________________________ Campus-Wide ID ______________
Bi-Weekly Monthly Extension ____________________
Designate my gift to unrestricted support for
Seaver College School of Law Athletics
School of Public Policy GSEP Center for the Arts
Pepperdine University
Graziadio School
University Libraries
Or apply my deduction to this program/purpose _______________________________________________________
I hereby authorize Pepperdine University to deduct $_____________________________________ from each paycheck
starting ____________ (This date must be a regular payday).
I understand that this agreement will continue until payroll is notified of any changes in writing.
______________________________________________________________________________________________________
Employee (Signature) Print Name Date
For Office Use Only
Deduction Code ______________________ Received by __________________________________ Date Received _____________________
Thank you for returning your completed form to the Pepperdine Fund - Mail Code 4579
Version: 11.24.15
Thank you for all you already do to make the Graziadio School of Business and Management great!
From positively affecting the lives of our students to keeping operations running smoothly, we appreciate you! Did
you know that there’s one other thing you can do to help our school? As a GSBM staff/faculty member, you have the
power to help with an annual gift of any size. Your gift has a snowball effect that helps garner more support from
foundations and corporations who like to see that we believe in our cause.
The easiest way to give? Fill out the payroll deduction form below, place it in an intercampus envelope to Mail Code
4579, and then you’re in place as a GSBM donor!
Thanks for joining this mission to make a great place to work even greater
by inspiring the outside community with our generosity!
