Payroll Deduction Form Donor InformationName * Required First Last Banner IDCPO * RequiredPhone Extension * RequiredGift InformationPlease designate my gift for: * RequiredBerea FundNamed Endowed FundProgram or DepartmentIf you selected Named Endowed Fund or Program or Department, list below:I authorize Berea to deduct the requested amount per payroll. * RequiredI receive checks * RequiredBi-weeklyMonthlyI am a * Required9-month employee10-month employee12-month employeeGifts is in Memory or HonorPlease make my gift (optional):In honor of:In memory of:Full name of person that you are making the gift in honor or memory of:Address of Honoree City State / Province / Region ConfirmationBy initialing below, I authorize Berea College to continue my payroll deduction until further notice. I understand that I may discontinue this agreement at any time. * RequiredSignature (by typing your name here you are authorizing this agreement) * RequiredComments *Make a one-time gift or sign up for an electronic funds transfer rather than payroll deduction.