Payroll Deduction Form

Employee Payroll Deduction Plan for Charitable Contributions

Gull Lake Community Schools is pleased to offer its employees an easy way to contribute to the Gull Lake Community Schools Foundation through an automatic payroll deduction plan. These deductions are tax deductible as defined by the IRS.
Name *

First Name Last Name
This form may be submitted any time. Deductions will begin after this form is submitted.
Donation

Please note: The amount of your contribution will be kept private.
Indicate how you would like your name(s) to appear on our list of donors in our annual report:
May add spouse's name, too. Ex: John and Mary Smith
Easy Payroll Deduction:

$2.00 $5.00 $10.00
- To stop deductions, notify the Payroll Department at the Administration Building.
One-time contribution amount:
Signature *

Your full signature. I authorize my employer to withhold this/these deduction(s). Clear
Date *

Month Day Year
This form will be forwarded to the Administration Building, attention Bonnie Kuepfer. If you have any questions, please contact your building liaison or your supervisor.

High School: Beth Rhodes

Middle School: Laurie Klok

Ryan Intermediate: Mary VanderWal

Richland Elementary: Karen Koets

Kellogg Elementary: Janelle Holland
Gull Lake Community Schools Foundation

10100 East D Avenue, Richland, MI 49083

Phone: 269.548.3428

Fax: 269.548.3401

Email: info@glcsf.org

www.glcsf.org
If you wish to keep a copy of this form, please print before clicking the "submit" button.
Should be Empty:

Employee Payroll Deduction Plan for Charitable Contributions

Donation