Employee Online Payroll Deduction

Employee Contribution Form

I choose to donate to the Enhabit Cares Foundation

Yes

*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

Yes

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Employee Information

Employee ID (Enhabit):

Name:*

First

Last

Address:*

Street AddressCityState / Province / RegionPostal / Zip Code

Phone

Area Code

Phone Number

E-mail*

Branch Office Code*

Your donation is tax deductible minus any fair value items.

Enter the characters from the box:

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