ACIF Payroll Deduction Form

ACIF Payroll Deduction Form

Please enter your first and last name below.*

Please enter your ADTRAV email address below.*

Please enter your address below.*

Please provide street address, city, state, and zip code.

Please select your donation amount per pay period below.

If electing a different amount than what is provided below, please select Other below and then enter your chosen amount in the next field.

If donating an amount other than what is listed above, please enter your amount below.

Please note this is for donations per pay period on an ongoing basis.

If you would like to make a one-time payroll deduction donation, please enter the amount below.

Please confirm your authorization for ADTRAV to deduct the amounts indicated in this form to support the ADTRAV Community Impact Foundation.*

Please type out your full name and today's date to confirm your payroll deduction and/or one-time payroll deduction.

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