Louis Vuitton Raffle

Fair Market Value = $1,990 • Tax Exemption # ORG0002736

DRAWING WILL BE HELD ON 12/9/22

You do not need to be present to win.

Purchase Tickets

You may purchase tickets using the online order form below. Med Center Health employees who wish to purchase via payroll deduction may use the payroll deduction form.

Online order form

Med Center Health Employees Payroll Deduction Form

Name*
First Middle Last
Employee Number*
Work Phone*
Home/Cell Phone*
Work Email*
Address*
Street Address City State ZIP Code
Number of Tickets*
Please enter a number greater than or equal to 1.
Total
Payroll Deduction Full Payment*
The full payment deduction will occur on your next pay period.
- Pay in full next pay period
Payroll Deduction Full or Split Payment*
You may choose to pay in full or split your payment between two pay periods. The first deduction will occur on your next pay period.
- Pay in full next pay period
- Split between two pay periods (2 or more tickets only)
Authorization for Payroll Deduction*
I hereby authorize the Accounting/Payroll department to deduct the total amount indicated above through payroll deduction. I also understand and agree that in the event my employment with Med Center Health (and/or its affiliated corporations) is terminated before this obligation is satisfied, Med Center Health (and/or its affiliated corporations) may deduct any or all amounts in excess of Federal Hourly Minimum Wage from my final paycheck as consideration for payment on this account and that I will remain responsible for entire balance which will be immediately due and owing. Selecting "I Agree" below is your electronic signature to this agreement.
- I agree
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Comments
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