Payroll DonationRichard2022-11-17T15:51:27-06:00 Payroll Deduction Form for JFR SFM employees to sign up for contributing through payroll deduction When hard times hit, the Jack’s Family Fund, is here to help. We provide assistance grants to those who have experienced a crisis resulting in an emergency financial need. For example, we have: contributed to a loved-one's funeral; purchased clothes and necessities for families who've suffered a devastating house fire; and, helped find temporary shelter and long-term housing for those who are suddenly homeless. Your gift, no matter the size, makes a difference. Because so many of our team members give, we are awarding an average of more than $4,900 in assistance grants each week. Your gift matters. Thank you for donating today! Can we count on you to help continue the Jack's Family Fund's work helping those who need it most?* Yes, I will give back No, not at this time Donations are completely voluntary. You may cancel your payroll deduction giving at any time by contacting payroll@eatatjacks.comWould you prefer to make a one-time donation?*If for whatever reason you are not comfortable with donating weekly through payroll deduction, you may always make a donation online through our secure donation page. Would you like to go there now? Yes No, thank you. Donate NowWeekly Donation Amount*Please deduct the following amount from my weekly paycheck: $1 $2 $5 $10 Remember: This is a tax-deductible contribution.Name* First Last Last 4 Digits of SSN* Email* Enter Email Confirm Email Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code SignatureCAPTCHADate Submitted: 12/13/2025EmailThis field is for validation purposes and should be left unchanged.
