OR2024 - Charity Day - Citizens Bank of the South

Employee Name

Would you like to participate in the Charity Day program for 2024? *

Local Charity of Choice *

First Love KidsChristian Life CenterWACO Empty Stocking FundBaldwin Empty Stocking FundGA Cancer SupportWorking For A Purpose Foundation, IncPlease select one or two (max) charities. If you select more than two charities, the first two selected will be used.

Please choose the method you would to donate via?Payroll Deduction: The easiest way to give!

Lump Sum *

USD

(Please make check payable to Citizens Bank of the South)

26x Payroll Deductions of: *

USD

Total Deduction:

$

Donor Confirmation - I choose to participate.

I authorize Citizens Bank of the South to deduct the Charity Day Donation from my payroll check beginning with the 1st payroll of 2024 and continuing until the last payroll of 2024 or the termination of my employment. If employment shall terminate, I will be responsible for the balance at that time.

I also understand that in order to be eligible for the Charity Day, I must make the following annual donation amount: 8 hours of my regular pay or $143.00 ($5.50 per pay period), whichever is greater. By making this donation, if it is the minimum required, it entitles me to one day off with pay that will be coded as a CHARITY DAY.

Employee Signature

1-877-99-CBOTS / cbots@cbots.com

1-877-99-CBOTS / cbots@cbots.com

OR2024 – Charity Day

Local Charity of Choice *

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