Ken LaChance Colleague Emergency Fund
payroll deduction form

The conception and creation of the Colleague Emergency Fund is dedicated to the memory and life of Ken LaChance for his contribution to Convergint Technologies and unwavering support of colleagues.

The sole purpose of the fund is to provide limited financial assistance to eligible colleagues who are experiencing unforeseeable economic hardship due to certain emergency situations. Ken’s support and generosity will live on in all those that he helped and those who we continue to help in his name.

Please consider making a donation!

Enter your full name

Provide your Convergint email address

Provide your phone number

This phone number may be used for verification purposes by Convergint payroll

Phone

Select your country

Canada

United States

For my payroll deduction(s), I would like to...

Start

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Select your election for contributions to the Ken LaChance Colleague Emergency Fund:

Ongoing payroll deductions

Single payroll deduction

I authorize Convergint to process the above payroll election. I acknowledge that any changes may take up to one additional pay cycle to become effective. All funds shall be transferred directly to Ken LaChance Fund, Inc.

Your typed name will serve as your eSignature

By submitting this application online, you agree to electronic signature. If you prefer, you may print and sign the completed document.

For questions regarding the Ken LaChance Colleague Emergency Fund program visit www.kenlachancefund.com. You can request assistance in completing this form or send questions and feedback to the CEF Program Administrator at CEFrequest@convergint.com.

Thank you for your support!

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Ken LaChance Colleague Emergency Fund payroll deduction form

Ken LaChance Colleague Emergency Fund
payroll deduction form