JBS USA Employee Campaign

United Way Weld County · JBS USA Employee Campaign

JBS Pledge

Organization(Required)

Employee ID(Required)

First Name(Required)

Last Name(Required)

Work Email(Required)

Personal Email(Required)

Personal Address

Street Address City State Zip

I authorize JBS USA to deduct the following amount per pay period

Pay schedule

I authorize my payroll

for one year

to be continuous until further notice

I authorize a ONE TIME deduction from my paycheck in the amount of

I want to make a ONE TIME donation with my credit/debit card

Credit/Debit

Amount

Credit Card

Card Details

Cardholder Name

Designation

Area of Greatest Need

Reading Great By 8 (reading to learn)

Thrive by 25 (mentoring young adults to succeed)

Weld’s Way Home (preventing and ending homelessness)

Aging Well (supporting older adults)

Connecting Weld (increasing visibility & accessibility of resources)

Other

Agency Name and Address

Signature(Required)

Date(Required)

MM slash DD slash YYYY

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