Donations –South Texas Health System E-Pledge Card

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*

Calendar of Events