Marshall Employee Payroll Deduction Form Employee Payroll Deduction Pledge Form Name* First Last Employee Number* Please enter your employee badge number.Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Please know that we do not share your information with other parties.Phone*Email* My Gift to Partner In Health:I would like to help provide quality healthcare services to the Western Slope of El Dorado County and pledge through Marshall Foundation for Community Health as indicated below:Please check applicable box:* Hour Club (one hour of your base salary per pay period. Best employee pledge and recognition. Employees who work less than 60 hours per pay period may join the Hour Club by pledging one-half hour of their base pay per pay period. Check here if that applies to you. $650 / $25 per pay period $520 / $20 per pay period $390 / $15 per pay period $260 / $10 per pay period $130 / $5 per pay period Other: See Below Other Amount (please enter 0 if selection is made above):* Please enter the amount you would like to contribute per pay period.Please use my gift for:* Where the need is greatest Other: (please specify below) Other Support:* Tell us the area or fund you would like to support. Please enter "NA" if selection is made above.NameThis field is for validation purposes and should be left unchanged.
