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Employee Contribution Form

I choose to donate to the Encompass Cares Foundation
I wish to donate the following amount per week*

*Contributions to be deducted from bi-weekly payroll and will continue until changed or terminated

Other weekly amount (in dollars)
I opt-out of donating to the foundation

*I realize that by opting out I am not eligible to participate in the Employee Emergency Relief Fund if the need arises.

Employee Information

Name:*
Address:*
Phone
-
E-mail*
Branch Office Code*

Your donation is tax deductible minus any fair value items.

If you prefer to make a one-time donation to the foundation, you may print and mail the Encompass Cares Contribution Form along with your check or money order, or you can donate by credit card from our secure online donation page