Payroll Deduction Form

By checking the box below, I give my consent to Arizona’s Children Association to deduct the above amount from
my paycheck each pay period. I understand that these deductions will continue indefinitely during my employment here, but that I am able to cancel or change my deduction at any time by contacting AzCA’s payroll department.
I give consent for AzCA to deduct my donation from my paycheck each pay period. *
Employee Signature *
clear