Westfields Hospital Foundation | 535 Hospital Road | New Richmond, WI 54017
Westfields Hospital & Clinic Foundation 
Payroll Deduction Donation Form
Thank you for your donation to the One Campaign. Please submit your payroll deduction donation by May 30, 2018. The deductions will start the first pay period in September 2018.

required fields are marked with *

By entering my initials below, I authorized these donations to be taken out of my paychecks starting September 2018. I understand if I check sustaining donor that I will have the option to change or stop my contributions each year during the ONE campaign.

Thank you for your contribution to the One employee giving campaign. Your pledge will make a world of difference to those we serve. A letter will be sent to acknowledge your donation. For a receipt for tax purposes, please refer to your year-end pay summary on Employee Self Service.
* Payment method - If you wish to make donations by credit card, please click here
Patient Care
Organization-wide support
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Initials
If you have any comments or notes regarding your gift, please write them here:
*Would you like to be a sustaining donor? (As a Sustaining donor, your charitable contribution, via 24 payroll deductions, will continue until you request a change. You will receive an annual opportunity to increase, decrease, discontinue or reallocate your gift. It's that simple! Thank you!)
*Would you like to be a sustaining donor? (As a Sustaining donor, your charitable contribution, via 24 payroll deductions, will continue until you request a change. You will receive an annual opportunity to increase, decrease, discontinue or reallocate your gift. It's that simple! Thank you!)