Faculty/Staff Payroll Deduction Form

About You

First Name: Required Field

Last Name: Required Field

Faculty/Staff ID Number Required Field

Contact Information

Email:

Address 1: Required Field

Address 2:

City:

State:

Zip:

Gift Information

Please direct my gift to: Required Field

My gift is effective as of: Required Field

Total number of deductions: Required Field

Amount per deduction: Required Field

Total gift amount (amount per deduction x total number of deductions): Required Field

Is this an on-going gift? Required Field

Is this an on-going gift? Yes
No

Other Instructions/Comments:

University of Wisconsin-Milwaukee