Central & Northern New Mexico Combined Federal Campaign (CFC)

Central & Northern New Mexico Combined Federal Campaign
CFC Campaign No. 0606 Online Pledge Form
1224 Pennsylvania NE, Suite C, Albuquerque, NM 87110
Please complete, print and submit this form to make your 2008 campaign pledge online.

IMPORTANT NOTES:
* You must print 2 copies of this form in addition to your electronic submission. Copy 1 is for your payroll department and must include your social security number and signature. Copy 2 is for your records. Thank you.
* Required fields are in RED UPPERCASE.

Information About You

FIRST NAME:	Middle Initial:	LAST NAME:

Social Security Number
(Write On Printout if Choosing Payroll Deduction)

__ __ __ - __ __ - __ __ __ __

FEDERAL AGENCY AND OFFICE:

WORK ADDRESS:

WORK CITY, STATE, ZIP:

Information About Your Contribution
Fill in the blanks below showing the amount of your payroll allotment, cash or check contribution, then use the "Calculate" button to determine and verify the total of your annual contribution.
NOTE: CFC organizations do not provide goods or services in whole or partial consideration for any contributions made to the organization via this pledge card.

Allotment Source:

Amount per Payroll Period:

Other Amount (cash/check payable to CFC):

TOTAL CONTRIBUTION:

Designated Gifts
To designate one or more charities or federated groups that appear on the list provided (click here to open a new window containing the current list), fill the charity or federation codes(s) and dollar amount(s) below, then use the "Verify" button to validate and check the total of your designations. Use the New FIVE-DIGIT CFC Codes Only.

Charity/Group Code (FIVE DIGITS):

Annual Amount:

Designation 1:

Designation 2:

Designation 3:

Designation 4:

Designation 5:

Undesignated Amount (adjusted with "Verify Designations" button):

Recognition Options
I authorize the CFC to release the information I have provided below to the charities I have designated on this pledge form:

Name:

Home Address or Email:

Pledge Amount (Check the "Yes" box to release the amount of your pledge(s) to your designated charities) Yes:

Payroll Deduction Authorization (Write On Printed Form)
I hereby authorize any agency of the United States Government by which I may be employed during 2009 to deduct the amount(s) shown above from my pay each pay period during the calendar year 2009 starting with the first pay period that begins in January and ending with the last pay period that begins in December, and to pay the amounts so deducted to the Combined Federal Campaign shown above. I understand that his authorization may be revoked by me in writing at any time before it expires.

Signature: ______________________________________ Date: __________