AltaMed

AltaMed Foundation Logo

Pledge Type

Tell us how much and how many installments

A. Ongoing deduction - recurring donation per pay period, do not have to renew each year

B. Annual commitment - donation per pay period x 26 pay periods, will have to renew after 26th installment

C. One-time deduction - donation per pay period x 1 pay period

Donation Type

Donation Amount

Make this gift anonymous

Employee information

First Name

Last Name

Mobile Number

Employee ID#

Work Site

Department

Solicitor (Giving Ambassador)

Address (Tax acknowledgement letter will be sent to this address)

City

State

Zip

Acknowledgement

I acknowledge that I am instructing my employer, AltaMed Health Services Corporation, to make automatic payroll deductions for my participation in the employee giving program.

I am aware that my payroll deductions are being directly contributed to the AltaMed Foundation, a 501c3 nonprofit organization, whose 501c3 Tax ID is: 95-4090420. I understand I can modify or cancel my participation at any time in the future.

I understand that my authorized deduction will stay in place for the length of time I have designated above unless I inform the Development department in writing of my decision to modify or cancel the deductions. There are no reimbursements once a deduct

I understand that my participation in the employee giving program is completely voluntary and that I will not receive compensation or benefits for my participation.

Please enter your full name below to confirm your participation in the program.

Total Donation Amount

If you selected option A, recurring payments, the total amount is the dollar amount per pay period that will be deducted and does not reflect the total donation you will make.