Liberty Hospital Foundation · Employee Giving Campaign Form FY21

How I plan to give

*

Payroll Deduction

PTO Hours

One-time Gift

Payroll Deduction

I authorize Liberty Hospital to make the deductions selected here from my paycheck as a one-time charitable contribution.

$150

$75

$50

$35

Other amount

One-Time Gift

Payroll Deduction

Credit Card

Check

Credit Card Amount

*

$250

$100

$50

$35

$

Donation Schedule

One-time Gift Amount

$250

$100

$50

$35

Other amount

What other amount?

Paid Time Off

Income taxes will be deducted from your PDO donation and will be reflected on your pay stub. Please enter a number from 8 to 500.

Notes about my gift

Your Information

Name

*

First Name

Last Name

Email

*

Verify Email

*

Employee ID Number

*