Employee Deduction Authorization Form

PAYROLL DEDUCTION

Request your deduction form

Give to the Employee Resource Fund straight from your paycheck. Your gift helps

Anthem team members get through unexpected hardship.
How it works

1

Request

Fill out the short form below.

2

You sign

Your form arrives by email. Choose your amount and sign.

3

Director signs

Your Staff Development Director approves it.

4

Payroll signs

Your deduction starts on the date you chose.
Full Name
Email Address
We'll send your form here. SHORE also uses this email for your annual giving receipt.
Community/Location
Not based at a community? Select Not applicable
SDD Email
example@example.com
Your form arrives from Jotform Sign within a minute or two.
Should be Empty:

Request your deduction form