Request Deduction

Company Information
Which Anderson company are you associated with?
Anderson Company*
Note: The Anderson Company you selected is processing payroll deductions with pledge forms and not this online form. Please contact your local payroll or human resources representative to learn more.
Note: The Anderson Company you selected is not currently processing payroll deductions. Please contact your local payroll or human resources representative to learn more.

Role Information
Information about your role within the participating Anderson companies.
Role*
Unfortunately the Foundation is not currently able to process settlement deductions for Company Drivers and Independent Contractors. Stay tuned for updates in the future. Please see the donations page to consider donating with one of the other donation options.

Contact Information
Information about the person requesting the payroll donation. Information provided below will be confirmed prior to setting up the payroll deduction.
Name*
First Last
Email*
Enter Email Confirm Email
Address*
Street Address Address Line 2 City State ZIP Code
Birthdate*
MM slash DD slash YYYY

(mm/dd/yyyy)

Donation Information
Financial information for the requested payroll deduction.
Per-Paycheck Donation Amount*
This amount will be deducted from each paycheck, based on your location's specific payroll cycles. Contact your payroll representative to make changes to these deductions.
Per-Settlement Donation Amount*
This amount will be deducted from each settlement, based on your specific settlement cycles. If you have no settlement, no donation will be processed (or accrued). Contact your settlement representative to make changes to these deductions.
Deduction Type*
- New Donation
- Change Existing Donation

Final Submission
Payroll deduction requests will be handled in a confidential manner by the Foundation governing committee.
Consent*
I agree to the statement below
I attest that the information provided in this application is accurate, truthful, and complete.

I am aware that fraudulent or misleading donation submissions may result in disciplinary action.
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Company Information