Give a George

Give a George
This authorizes the deduction of $Enter Amount* (the "Deductible amount") from my wages to be paid by Baptist Community Services ("BCS") and any of its affiliates. This amount is to be deducted from each regularly scheduled paycheck until cancelled, beginning with the pay period ending Date* .
Name

First NameLast Name
Badge Number
Purpose for Deduction
Employee Signature*
Date

MonthDayYear
Date
Should be Empty: