Elks Charitable Contribution Payroll Deduction Authorization

2750 N. Lakeview Avenue Chicago, IL 60614 - 1889 Phone: 773-755-4700

Elks Charitable Contribution Payroll Deduction Authorization In the spirit of “Elks Care Elks Share” effective November 1, 2004 employees will have the opportunity to “Share” a portion of their paychecks by making a donation to the Elks National Foundation, the Elks National Veterans Service Commission and /or the Elks Veterans Memorial Restoration Trust through payroll deduction.

Elks National Foundation: funds programs that instill integrity in our youth, inspire the pursuit of knowledge and make the community a healthier, safer and better place to live.

Elks National Veterans Service Commission: funds programs and activities that enhance the level of comfort for all veterans.

Elks Veterans Memorial Restoration Trust: funds the preservation and restoration of the Elks Memorial Building.

Contributions: Minimum contribution amount is $5 per payroll. Contributions will be deducted after-taxes.

Employee Benefits: Support of a good cause, tax deduction and “Casual Fridays*.”

*To promote participation, participants may come to work in business appropriate casual attire on Fridays. (The following will apply to casual Fridays: no tank tops, no T-shirts with sayings on them, no ripped or stained jeans, shorts must be knee length, no sweatpants or workout-type attire, etc.)

To participate, complete the form below and return it to Human Resources.

PAYROLL DEDUCTION AUTHORIZATION

Employee Name: ______SS# ______-______-______

Effective Paycheck Date: _____/_____/_____

Check one: Begin Charitable Contribution Deduction

I wish to donate to the following: Elks National Foundation $5.00 Other Amount $______

Elks National Veterans Service Commission $5.00 Other Amount $______

Elks Veterans Memorial Restoration Trust $5.00 Other Amount $______

Remove/Discontinue Charitable Contribution Deduction

This authorization is to remain in effect until COMPANY receives written notice from me of its termination.

Employee Signature: ______Date: _____/_____/_____

D:\Docs\2017-12-14\0b85f3bd7d5b262f4d51899c6da6680c.doc REVISED: 10/11/2004

BPO Elks of USA reserves the right to modify or discontinue procedures, practices, policies and benefits at any time. Payroll Department Use Only: Employee # ______Effective Pay date: _____/_____/_____

D:\Docs\2017-12-14\0b85f3bd7d5b262f4d51899c6da6680c.doc REVISED: 10/11/2004

BPO Elks of USA reserves the right to modify or discontinue procedures, practices, policies and benefits at any time.