2025 Montage Campaign Payroll Deduction Contribution

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Thank you for your support of United Way Monterey County through the Montage Health Employee Giving Campaign. You are making a difference in our community. You have selected payroll deduction as your contribution method. Please complete this form by December 6, 2025. You will receive an electronic acknowledgment of your gift. For questions, please contact your employee campaign manager Cheryl Gindhart Moore.

Do you want to change your payroll deduction contribution amount?

No problem! Simply fill out the form below with the NEW amount you would like deducted out of each paycheck.

Starting January 1, 2026 your new donation amount will automatically be deducted from your paycheck.

Employee Information

First Name

Last Name

Address

Address 2

City

State

Zip Code

Email Address

Phone Number

Employee ID Number

This is your employee ID number. It is required for setting up your payroll deductions. Example: 1234 or 12345 or 123456

Employee ID Number

Please re-enter your employee ID number.

I wish to remain anonymous

I agree

ROLLOVER PLEDGE: I understand that this pledge is ongoing and I authorize CHOMP to make the above deduction from my paycheck until I notify the Payroll & Benefits department otherwise.

Emerging Leaders Society

I want to be part of United Way's Emerging Leaders Society (ELS), a new generation of leaders ages 21-35 who are committed to BIG and LASTING CHANGE in our community. To support our work, I commit to an annual gift of $100 or more.

Payroll Deduction Amount

Total Contribution Amount Based on 26 Pay Periods

$5 per pay period = $130

$10 per pay period = $260

$25 per pay period = $650

$50 per pay period = $1300

$100 per pay period = $2600

Other amount per pay period

Enter other Amount

Contribution Total $ 0

-OR- One Time Payroll Deduction

If you only want your contribution to come out in one pay period, please enter the total amount here.

Donor Notes

Designation Options

You have the option to designate your donation to an external 501(c)(3) nonprofit agency outside of United Way Monterey County.

To designate funds to an external agency, each agency you select must receive a minimum of $100 annually. (United Way Monterey County programs do not need a minimum donation amount.)

For example, if you choose payroll deductions and pledge $5 per pay period for a total annual donation of $130, this allows you to designate to one external agency. If you wish to designate to multiple agencies, your annual contribution must be at least $100 per agency.

Example: If you want to support three external agencies, your annual donation would need to be $300 (or $100 for each agency). This would mean a payroll deduction of at least $12 per pay period.

This ensures each agency receives impactful support while allowing you to make a difference through your workplace giving. Thank you for your generosity and support!

Please direct my contribution to the following non-profit organization ($100 minimum annually per designated organization). You can search GuideStar to find a full list of 501 (c) (3) nonprofits.

(If no non-profit is specified, your contribution will be given to United Way Monterey County General Fund.)

Agency of Choice 1

Agency of Choice 2

Agency of Choice 3

Or, please designate my contribution to a specific United Way Program:

211

Emerging Leaders Society

Family, Friends, and Neighbors

Financial Literacy Education

Preschool Service Corps

Stuff the Bus

Volunteer Income Tax Assistance (VITA)

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