(
*
indicates a required field.)
*
1). Banner ID
*
2). Name
*
3). Dept./Office
*
4). ACU Box
*
5). ACU Phone
6). Email address
7). If spouse's employer matches gifts, give company name:
*
8). Gift Designation 1
*
9). Gift amount 1 (per month)
10). Gift designation 2
11). Gift amount 2 (per month)
12). Gift designation 3
13). Gift amount 3 (per month)
*
14). I am paid:
Once per month
Twice per month
15). By checking this box, I agree to have the designated amount withdrawn from my paycheck.
Yes. I agree.