TEAMCARE

LEAF

If you would like to donate any part of your salary as a personal contribution to LEAF, LandCare’s education assistance fund, please complete the form below. Your contribution to the fund may be tax deductible.

If you have any questions about paycheck deductions, please reach out to Kristen Waters at (240) 446-8942 or
Kristen.Waters@LandCare.com.

LEAF Team Member Donation Form

Request Type*
- New request
- Change to an existing donation
- Stop my current donation
Name:*
First Last
Title:*
Last 4 Digits of Social Security Number (SSN):*
Branch Name:*
Personal Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

We will use this address to send you a tax write-off letter
Phone:
Email:
Recurring Donation Amount
If 'Other', please enter the amount we may deduct per paycheck.
- $2 Per Paycheck
- $5 Per Paycheck
- $10 Per Paycheck
- $15 Per Paycheck
Other Amount (Recurring):
If you would like to submit a different recurring amount, please enter the amount you would like deducted per paycheck. For example: '$1 / paycheck'
Donation Date
Please select the date you would like the donation to start (Friday dates only):
MM slash DD slash YYYY
By typing my name, I authorize LandCare USA LLC to deduct the amount listed above from my paycheck. I understand that this is a voluntary payroll deduction and I can change or stop this deduction at any time:*
Today's date:*
MM slash DD slash YYYY