HTML Preview Salary Deduction Letter page number 1.
MONTHLY DEDUCTION
LETTER OF COMMITMENT
NSU Foundation • Office of Development
812 N. Cedar • Tahlequah, OK 74464 • 918-458-2143
Monthly Payments will be made by:
Payroll Deduction
monthly
Check
Credit Card
Bank Draft (must provide a VOIDED check along with form)
(NOTE: Bank drafts will be processed/withdrawn the first day of each month.)
NOTE: Selection of the “Payroll Deduction” option indicates that you authorize the Payroll Department of the Business
Affairs Offices to make monthly payroll deductions from your payroll check. This deduction represents a gift to The
Northeastern State University Foundation, Inc.
Choice of credit cards:
Please
Circle
One
Visa
MasterCard
AMEX
Discover
Card #:
Expiration Date:
Authorization Code:
Signature:
Date:
Personal Information:
Name (please print):
Banner ID#:
Address:
City:
State:
Zip:
Home Phone:
Business Phone:
Email:
Please direct my Employee Giving Donation to:
Additional Comments:
Signature:
Date:
Email form to: g[email protected]
Or send through campus mail to Peggy Glenn Office of Development
If you have questions, please call ext. 4200