Donations –South Texas Health System E-Pledge Card South Texas Health System E-Pledge Form Name/Nombre* First Middle Last Hospital Name* Department/Departamento* Last four of your SS#/Últimos 4 números del Seguro Social* Complete Employee ID #/Número Completo de Empleado* Donation Method* I choose to give through Payroll I choose to give through PayPal To give through paypal, please click here.Pay Period Frequency/Frecuencia de Periodo de Pago* Bi-Weekly/Cada Quincena Donation Amount/Cantidad de Donacion* Email/Correo Electrónico* I authorize South Texas Health System Payroll Department to process the pledge information entered above for payroll deduction. Yo autorizo a el Departamento de Nómina a procesar la información de compromiso para la deducción de nómina* Agree Signature (Print Full Name in Box Below)* Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Signature* Reset signature Signature locked. Reset to sign again Δ
