Volunteer Information

CPTC Staff & Faculty Electronic Payroll Deduction Authorization & Change Form

The following provides critical information to ensure payroll makes accurate changes for you. It also allows the Foundation to correctly record your gift. Please hit next at the bottom of the page to complete the donation request.

Ongoing payroll deductions authorize CPTC Foundation to deduct the amounts specified below per pay period for 24 payments per year. This will continue each year until such time as employment is terminated or a change is requested. One-time payroll deductions authorize CPTC Foundation to make a one-time deduction for the amount specified below.

Your payroll deduction can be as low as $1.00 per paycheck. Every dollar donated makes a difference!

* Required Fields

Contact Information

First Name

Last Name

Address (For End of Year Tax Letters)

Address 2

City

State/Province

Zip/Postal Code

Cell Phone

Work Phone

Employee ID#

Birthdate

Donation Information

Authorization to Deduct/Change:

Month to Begin Deduction/Change:

Payroll Donation Type

Direct My Gift Toward:

Designate other gifts here:

Gift Information (Please specify changes to existing donations here):

Deduction Amount per Pay Period:

Privacy Policy
We take precautions to protect your information. We collect credit card or bank account information, names, addresses, and other data related to your transaction when you make a payment through our site. We use this information to process your payment.

Terms/Conditions
By submitting your payment, you authorize us to charge the account above for the amount specified in the Transaction Amount field. Account information for Recurring Pledges/Monthly Giving is encrypted and stored securely via SafeSave™ for automatic processing of your future payments. Notify us at anytime if you wish to discontinue your pledge.