Employee Giving Pledge Form - Virginia Mason Franciscan Health Foundation

Multiple fund Payroll Deduction Form

Employee Information

First Name*

Last Name*

Employee ID #*

Work Email*

Work Phone Number (including extension)*

Mail Stop

Gift Information

Note: One Time Payroll Deduction will be taken out of the first pay period of fiscal year 2023, which begins in July 2022. Recurring Payroll Deductions will start in July 2022 and end in June 2023. Questions? Please contact the Virginia Mason Franciscan Health Foundation at 206-583-6083.

Gift Frequency

One Time Payroll Deduction

Recurring Payroll Deduction

Recurring Gift Amount

I would like to designate my gift to the VMFH fund

Second Recurring Gift Amount

Second VMFH fund designation

Third Recurring Gift Amount

Third VMFH fund designation