Binghamton University Foundation Payroll Deduction Authorization

Please complete this form, print the confirmation page and send it to the
Binghamton University Foundation, Old O'Connor Hall G044
The address is also on the confirmation page.
Questions? Call 607-777-6929
* First, MI, Last Name
 * B Number     Lookup
* Department/Location
 * Campus Extension
 Class Year (If Binghamton graduate)
Home Address
City
 State
Zip
* Email Address
* Employer:   State       Research Foundation
* Payroll deduction will continue until you send written notice directly to your appropriate payroll office requesting the deduction be discontinued, or until you submit a new form to the Foundation office with the "Cancel" option selected.
(Check to confirm you have read this contractually binding information.)
* If you wish to change your bi-weekly payroll deduction amount, you must file a new authorization form with the Foundation office. If you wish to change only your gift account designation, contact the Foundation office at 607-777-6929.
(Check to confirm you have read this contractually binding information.)
* You will receive an official tax receipt letter each January from the Binghamton University Foundation acknowledging your cumulative payroll deduction giving for the previous tax year.
(Check to confirm you have read this contractually binding information.)
I wish to:
  Start payroll deduction: 		Bi-weekly amount $
      Is this a joint gift?     Yes     No
     
                  Spouse/Partner's Name
  Change bi-weekly deduction: Current deduction is $ , change to $
  Cancel payroll deduction
Unless otherwise noted in your annual payroll deduction tax receipt letter, no goods or services in whole or partial consideration are provided for contributions made to the Binghamton University Foundation by payroll deduction.
Direct my Binghamton Fund giving to:
$   Bi-weekly
                         Add another account
Or specify another department or fund/account number
$   Bi-weekly
Any additional notes
Questions? Email givenow@binghamton.edu.

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