ECHO Pledge Change Form

Name*

First Last

Employee Number*

Entity*

Department*

I want to modify my participation in ECHO payroll deduction.*

Current Pledge Amount*

Please consider an amount decrease instead of discontinuing your gift. We are grateful for you.

New Amount to be Deducted Per Pay Period*

Authorization

I understand that, in the case where I have completed multiple authorization forms, the most recent authorization form will supercede all others.

Signature*

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Comments

This field is for validation purposes and should be left unchanged.