Workplace giving authorisation form Yes I ll help the by inthefire

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									Workplace giving
authorisation form

Yes, I’ll help the mission to defeat cancer! To authorise regular donations from your pay
for The Cancer Council NSW please complete the form below. Please give this form to
your Payroll Manager and send a copy to Direct Marketing, The Cancer Council NSW,
Kings Cross, NSW 1340 or fax to The Cancer Council NSW on 02 9357 2676.

To authorise regular deductions from your pay, please complete the details below and return to
your Payroll Manager.

Full Name:

Company:

Employee Payroll Number:                       Extension:

Business Unit:

Email Address:

Work Phone Number/Extension:

Home Address:

Suburb:                        State:          Postcode:

Telephone: Home:                               Mobile:


I would like to donate the following amount each pay period to The Cancer Council NSW:

       $50             $30              $10              Other:_______

Please deduct this amount from my regular pay and transmit to The Cancer Council NSW. I
authorise deductions to commence on the first pay date after receipt of this authorisation. This
authority will remain in force until cancelled in writing.

Signature: ______________________________________ Date:_______________________________

Please send this form to your Payroll Manager and mail / fax a copy to : Direct Marketing,
The Cancer Council NSW, Kings Cross, NSW 1340 or fax to The Cancer Council NSW on 02 9357
2676.

Thank you for your support.


Information for Payroll Managers:
Each pay period please send The Cancer Council NSW the information we require to process
these donations. For payment and transfer of donor and donation details please contact us on
1300 780 113 or email pledge@nswcc.org.au and we will send you all required information,
including The Cancer Council NSW account and BSB details.
Thank you.

								
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