Survey - Pledge to a CCB Brick Paver via Payroll

Pledge to a CCB Brick Paver via Payroll

Your pledge will be divided into 52 pay periods, unless otherwise indicated. If you wish to fulfill your pledge sooner, please contact Liz Curnett at 513-636-4484 or liz.curnett@cchmc.org.

The 8 by 8 paver is $48.08 per pay period ($2,500 total).
The 4 by 8 paver is $19.23 per pay period ($1,000 total).

Question - Required - What size paver would you like to purchase?

8" by 8" paver - 6 lines with 18 characters per line

4" by 8" paver - 3 lines with 18 characters per line

Question - Required - I prefer to make this donation anonymously.

Question - Required - Employee ID:

Question - Required - Last four digits of your social security #:

Question - Not Required - Enter your preferred engraving (Line 1/18 characters)

Question - Not Required - Enter your preferred engraving (Line 2/18 characters)

Question - Not Required - Enter your preferred engraving (Line 3/18 characters)

Question - Not Required - Enter your preferred engraving (Line 4/18 characters)

Question - Not Required - Enter your preferred engraving (Line 5/18 characters)

Question - Not Required - Enter your preferred engraving (Line 6/18 characters)

Contact Information


*	Title:
*	First Name: Required
*	Last Name: Required
*	Email: Required
*	Street 1: Required
*	City: Required
*	State / Province: Required
*	ZIP / Postal Code: Required
*	Phone Number: Required
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Thank you for supporting Cincinnati Children’s!

Pledge to a CCB Brick Paver via Payroll

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