Bethel University Annual Fund
Bethel University Donation Employee Payroll Deduction Change FormEmployee InformationName FORMTEXT ????_______________________________?ID FORMTEXT ?????PO FORMTEXT ?????Change Amount I wish to change my Bethel Annual Fund payroll deduction: FORMCHECKBOX Please begin / increase my monthly payroll deduction amount to $ FORMTEXT ????? beginning with the (month) FORMTEXT ????? pay cycle.Please direct my contribution to: FORMCHECKBOX Bethel University where needed most (Annual Fund) FORMCHECKBOX Other FORMTEXT ????? FORMCHECKBOX Please decrease my monthly payroll deduction amount to $ FORMTEXT ????? beginning with the (month) FORMTEXT ????? pay cycle.Discontinue Deduction FORMCHECKBOX Please discontinue my monthly payroll deduction beginning with the (month) FORMTEXT ????? pay cycle.AuthorizationSignature _________________________________________________________________________________ Date______________________Return signed form to the Office of Human Resources on the 5th floor of the Anderson Center or as an attachment to bethelhr@bethel.edu. Contact the Office of Human Resources at 651-638-6119 or bethelhr@bethel.edu if you have questions. Please keep a copy for your records. The change form must be received by the 15th of the month to be processed for that month’s pay cycle. ................
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