Employee Giving Form

First Name Last Name

Address

City/State/Zip

Home Phone
Cell Phone

Email
CHR Location/Department

My Total Annual Gift $
per paycheck for
Method of Payment:
Check (Please make checks payable to CHR)
Payroll Deduction

# of pay periods

Credit Card/Online - Click Here

Cash

By checking this box and typing my name and date below, I am electronically signing my pledge form

Yes Date:

Please keep my donation confidential

For more information or questions regarding the 2022 employee giving campaign please contact

Katie Reaves at kreaves@chrhealth.org or 860-697-3381
**Please email your pledge form to Katie Reaves at kreaves@chrhealth.org.**
**Checks can be mailed to the Windsor Main Office**

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Ways to Give

Employee Giving Form

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