Tabitha Health Care Services : Commit2Give : Payroll Deduction and PTO Form

We invite you to further invest in our mission by giving to Tabitha via payroll deduction or donating PTO.

First Name

Last Name

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Address

City

State

Zip

Donation Status

I'm a new TEAMember
I'm a new donor
I'm a current donor and want to increase my donation

Donation Amount

I pledge to give each pay period through automatic payroll deduction, beginning with the next pay period:

Other Amount

Use my gift to support:

PTO

I'm interested in donating PTO hours

Number of PTO Hours to Donate

I request that the following number of hours from my Paid Time Off (PTO) balance be paid directly to Tabitha rather than to me. By completing this form, I acknowldege that I understand that I am responsible for paying the applicable taxes on the wages for these PTO hours.

Signature

Please type your first and last name to acknowledge the terms above.

Verification

By checking this box I verify that the information is accurate and I agree to the terms listed above.

Make a One-Time Donation

Thank you for devoting your time, talent and treasure to Tabitha's mission!