GEORGETOWN COLLEGE

Payroll Deduction Form

Please Print and Mail Completed Form to the Development Office
 400 East College Street; Georgetown, KY 40324
502-863-8089

PAYROLL DEDUCTION AUTHORIZATION

In appreciation of Georgetown College and in consideration of the gifts of others, I authorize the following payroll deduction as my contribution:

Please check one:  __ Begin my payroll deduction plan.   __ Change my payroll deduction plan.

Additional funds will be forthcoming through matching funds from my spouse's company, ______________________________________(company's name).

DESIGNATION:

___ Unrestricted support of the annual operating budget

___ Henlein Faculty Development Fund Endowment

___ President's Club ($1,000 per fiscal year [$83.34 per month])

___ Other (please specify) ________________________________________________________

METHOD:

$ _____________ one-time gift in the month of ___________, 20_____

$ _____________ weekly until further notice

$ _____________ monthly until further notice

Name: _____________________________________________Phone Number: ______________

Signature (required): ____________________________________Date: ____________________

If you have any questions, please give us a call at 863-8089 and we will be happy to assist you. Our new fiscal year begins July 1, but payroll deduction can begin at anytime during the year.