HHS Payroll Deduction Form

If you are not an HHS staff member, please make your donation here.

HHS Employee Payroll Deduction

Fields with an "*" are mandatory.

HHS Employee Number*

First Name*

Last Name*

Email Address*

Home Address*

Home Phone*

Select Payment Option:

Option A	I authorize an ongoing deduction each pay, until I give further notice.
Option B	I authorize a pledge amount for a number of pays (e.g. - $5 x 26 pays = $130 Pledge Total).
Option C	I authorize a one-time gift to be deducted.

Deduction Amount *

(option B only)
For how many pay periods?*

(option B only)
Pledge Total ?*

Designate gift to this area of HHS*

Any specific program there?

I give Hamilton Health Sciences and Foundation permission to contact me by email.

Hamilton Health Sciences Foundation is committed to protecting your personal information. We do not share, rent, trade or sell any information we have collected. Personal information collected may be used to conduct fundraising and donor relations activities in support of Hamilton Health Sciences. If, at any time, you wish to be removed from our list or to obtain a copy of our Information Privacy Policy, please contact the Foundation at (905) 522-3863 or via email at info@hamiltonhealth.ca.

Tax receipts are issued for all donations. Monthly donors will receive one receipt at the end of the year for the full amount of their annual donations.

Charitable Registration No: 131159543 RR0001.

If you are not an HHS employee, please make your donation here.