Benevolent Fund Payroll Form

Employee Information

First Name: Required Field

Last Name: Required Field

Official UAB Email: Required Field

Blazer ID: Required Field

Pay Category: Required Field

Pay Schedule:

Pay Schedule: Monthly
Biweekly

This gift should remain anonymous

Credit or Debit Card

To make a gift via credit or debit card, please use the form found here.

Choose up to two (2) Areas of Support

You may select up to two (2) designations as recipients of your contribution.

Designated Nonprofit 1: Required Field

Designated Nonprofit 2:

Is this pledge intended to replace a current pledge to the Benevolent Fund?

Is this pledge intended to replace a current pledge to the Benevolent Fund? Yes
No

One Time Gift

Provide us with the one-time gift amount and indicate the date of this deduction.

I would like to make a
one-time gift of:

Please deduct my one-time gift on:
Month/Year: (MM/YYYY)

Monthly Gift (automatic monthly renewal)

Provide us with the total amount to be deducted from each paycheck and indicate the start of this deduction.

I would like to show my support with
a monthly deduction of:

Please BEGIN my deductions on:
Month/Year (MM/YYYY):

Pledge Installments (finite number of payments)

Provide us with the total pledge and indicate the duration of this pledge.

I would like to show my support with a total pledge of:

Please BEGIN my pledge payments on:
Month/Year (MM/YYYY):

Duration of pledge
(2-60 months):

Please watch for an email immediately following the completion of this form for confirmation of your payroll deduction.

For questions, please contact UAB Gift and Biographical Records by phone at 205.934.7242 or via email at gifts@uab.edu