EAC/STA Well Payroll Deduction Authorization
Below are donation options to the EAC/STA Well. Only one deduction method is required, but all three can be filled out if preferred.
I hereby authorize Spokane Transit to withhold from my wages:
A bi-weekly monetary donation for the EAC in the amount of: (Please select the amount below. If you wish to give a different amount, please select other).
Please Select
$0
$3
$4
$5
$6
$7
$8
Other
A bi-weekly monetary donation for the EAC in the amount of:
A bi-weekly monetary donation for STA-Well in the amount of: (Please select the amount below. if you wish to give a different amount, please select other).
Please Select
$0
$3
$4
$5
$6
$7
$8
Other
A bi-weekly monetary donation for STA-Well in the amount of:
An annual monetary donation for the EAC in the amount indicated below, beginning with the next pay period and then annually thereafter on the first payday of the year.
An annual monetary donation for STA-Well in the amount indicated below, beginning with the next pay period and then annually thereafter on the first payday of the year.
A one-time monetary deduction for the EAC in the amount of:
A one-time monetary deduction for STA Well in the amount of:
I understand my donation is voluntary and has not been made as a condition of my continued employment. I authorize the selected donation amounts indicated above to be given to the EAC and/or STA-Well through a bi-weekly payroll deduction. I understand this authorization will remain in effect until cancelled by myself or Spokane Transit.
*
Yes
No
Name
*
First Name
Last Name
Employee ID
*
Date
*
-
Month
-
Day
Year
Date
Signature
*
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Should be Empty: