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Give Back Today
Give Back Today
Give Back Today
Kailee Hominick
2019-05-10T17:44:35+00:00
Payroll Deduction Form
Giving through payroll deduction quick, easy, and
meaningful.
First
Last
Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Afghanistan
Åland Islands
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Guinea-Bissau
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Iraq
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Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
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Lithuania
Luxembourg
Macao
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Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
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Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
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Monaco
Mongolia
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Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
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Nigeria
Niue
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Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
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Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
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Samoa
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Senegal
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Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
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Sudan
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Switzerland
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Taiwan, Province of China
Tajikistan
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Tuvalu
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Ukraine
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Vanuatu
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Viet Nam
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Wallis and Futuna
Western Sahara
Yemen
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Zimbabwe
Country
Phone
Email
*
Gift Details
I would like my gift to be directed to:
*
Capital Campaign
Area of Greatest Need
Financial Aid (General Strong Kids)
Community Y
Community Y Basketball
Big Cove
Immigrant Services
Child Care
YPHD
Employment
I would like to give the following amount each pay period:
*
I would like my deductions to begin on:
September 1st
September 15th
October 1st
Other
I would like my payroll deducted:
*
Indefinitely, until I ask them to stop or change.
For One Year
Once
Other:
I would like my gift to be acknowledged as:
*
Among Donor Listings
Anonymous
Planned Giving
I have made provisions for the YMCA of Greater Halifax/Dartmouth in my will.
I would like to receive information about including the YMCA of Greater Halifax/Dartmouth in my will.
Please send me information about Planned Gifts (e.g., life insurance policy, bequest).
I understand that I am agreeing to a payroll deduction through this form in lieu of a signed document.
*
Yes
Message
Submit