Support With Purpose Through Payroll Contribution

Thank you for choosing to support the work of the Signature Inspire Foundation through payroll contributions. Your tax-exempt gift is an impactful way to demonstrate your dedication to our mission and to inspire others to follow your meaningful example.

Please complete the form to start or update your contribution. *Note: To increase your gift, please input the new total amount you would like to contribute, and it will be adjusted during payroll processing.

Stakeholder Information

Stakeholder First Name

Stakeholder Last Name

Email Address

Please provide your 9 digit Stakeholder ID

Facility

Please Select your Stakeholder Status:

Contribution Information

Please fill out the information below:

I wish to enroll in automatic payroll contributions to the Signature Inspire Foundation, a 501(c)(3) tax exempt organization, in the amount set forth below:I wish to increase my automatic payroll contributions to the Signature Inspire Foundation, a 501(c)(3) tax exempt organization, to the amount set forth below:

Amount of Contribution Per Pay Period (Please only choose one option):

$1$2$5 - Enroll at this level or higher to receive a FREE T-Shirt!$10$15$20$30Other

Other Amount

By signing below, I authorize Stakeholder Payroll Services, LLC to make the above specified changes from the wages due to me for each payroll period from the date of this authorization. I understand also that it may take up to a full payroll period for changes I make via the form to take effect. A facsimile or electronic submission of this form shall have the same validity as the original.

Date

Please provide your T-Shirt Size if you enrolled at $5.00 or higher

Please provide your shipping address to receive your FREE Signature Inspire Foundation T-Shirt

*You must enroll at $5 or more per pay period to receive your one free t-shirt.