Paid Time Off Donation Request Form Page 3
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3Paid Time Off Donation Request Form
Date of request:
Employee name:
Manager’s name:
Amount of PTO you wish to donate:
Charitable Organization Information:
Name:
Contact:
Phone:
Email:
Address:
City/State/Zip:
Website:
Federal Tax ID number:
Employee signature
date
Manager’s signature
date
HR signature
date
SUBMIT COMPLETED FORM TO: ___________________________
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