Your Land. Our Care.

Request Type*

New request
Change to an existing donation
Stop my current donation

Name:*

First Last

Title:*

Please list your name as you would like it to appear on our LEAF Donor list:

Select if you would like to donate Anonymously

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:

Option 1: Recurring Donation

If 'Other', please enter the amount we may deduct on a weekly/biweekly basis.

$100 Annual Donation..............($1.92 weekly deduction / $3.85 bi-weekly deduction)
$250 Annual Donation..............($4.81 weekly deduction / $9.62 bi-weekly deduction)
$500 Annual Donation..............($9.62 weekly deduction / $19.23 bi-weekly deduction)
$1,000 Annual Donation...........($19.23 weekly deduction / $38.46 bi-weekly deduction)
$1,500 Annual Donation...........($28.85 weekly deduction / $57.69 bi-weekly deduction)
$2,500 Annual Donation...........($48.08 weekly deduction / $96.15 bi-weekly deduction)

Other Amount (Recurring):

If you would like to submit a different recurring amount, please enter the amount below followed by 'weekly' or 'bi-weekly' deduction. For example: '$2 / weekly'

Please select the date you would like the donation to start (Friday dates only):

OPTION 2: One-time Donation from Salary

If ‘Other’, please enter the amount you would like to donate.

$25
$50
$100

Other Amount (One-time):

If you would like to submit a different one-time donation amount, please enter the amount below.

Please select the date you would like the donation to start (Friday dates only):

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:*

LEAF Employee Salary Donation Election Form

LEAF Employee Salary Donation Form