Haworth Member Relief Fund Donation Form

Haworth Member Relief Fund Donation Form

The Haworth Member Relief Fund is a program designed to help our members facing financial hardships, providing short-term monetary support when they need it most.

By donating to our relief fund, you are helping fellow Haworth members in times of need. Donations up to $500 per member per year are eligible to be matched through the Haworth Helps Matching Gift Program.

Complete the form below to request a one-time payroll-deducted donation.

Member Name*

First NameLast Name

Member ID Number*

Numerical Member ID, not 4-digit User ID

Member Email*

example@example.com

Member Phone Number*

Please enter a valid phone number.

Member Home Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

One-Time Payroll Deduction*

Donation Amount (Minimum $5)

By signing this form, I authorize Haworth, Inc. to make a one-time payroll deduction that will be donated on my behalf to the Haworth Member Relief Fund through the Helping Hands Charitable Foundation, a 501(c)3 organization. I also understand the following:

The amount I provided above will be deducted from my next paycheck if this form is submitted by 5 p.m. ET on the Friday before the next scheduled payday. If submitted after, it will be deducted from my following paycheck.
The wages withheld for my donation will be subject to applicable taxes and deductions.
The information I provided above will be shared with Helping Hands Charitable for the purpose of fulfilling my donation and to Haworth Helps for matching gift processing.

Member Signature*

Date*

Please note that after you submit this donation form, you will receive a copy of it via the email address you provided above. If your total annual donations amount to $250 or more, you will receive a receipt confirming your donations directly from Helping Hands Charitable Foundation in January next year. You can use this receipt—or any relevant pay stubs if you contributed less than $250—as documentation when claiming charitable donations on your tax return.