Survey - Employee Payroll Deduction (U.S. Only) - Herbalife Nutrition Foundation

Employee Payroll Deduction (U.S. Only)

If you would like to make your donation with your credit card, please CLICK HERE

*1.

Question - Required - First Name:

*2.

Question - Required - Last Name:

*3.

Question - Required - U.S. Herbalife Employee Payroll #:

*4.

Question - Required - Herbalife Email:

*5.

Question - Required - Best contact number:

(Maximum response 255 chars, approx. 5 rows of text)

*6.

Question - Required - Herbalife Office Location:

Question - Not Required - If remote, please specify City & State.

Question - Not Required - Date of Birth *Optional

Month

Day

Year

*9.

Question - Required - I would like to make:

A Recurring Donation with Payroll Deduction

A One-Time Donation with Payroll Deduction

*10.

Question - Required - Donation Amount:

11.

Question - Not Required - Please select Yes if you are increasing your donation amount. We will deduct this new amount moving forward.

*Automatic payroll deductions available for US employees only. Deductions are scheduled to begin in the next pay period until the indicated end date. If no end date is given, donations will recur indefinitely or until you contact us with an end date.

Donation amount is in US currency. If my payroll period earnings become insufficient (due to leave of absence, disability, etc.) to cover the donation, no funds will be taken out from my pay check. In addition, no retroactive or catch-up payments will be deducted from my future pay checks. If my earnings become sufficient again, the payroll deduction resumes. Once the donation has been processed, donation amount cannot be refunded. Payroll deduction ends on the specified donation end date. Payroll deduction can be cancelled anytime by submitting a written cancellation notice to the Herbalife Nutrition Foundation at 800 W. Olympic Blvd, Suite 406, Los Angeles, CA 90015 or by sending an email to the [email protected]. The request must be received by the Foundation two weeks prior to payroll processing to take effect immediately. Otherwise, cancellation will be take effect on the next payroll period. Your donation may qualify as a charitable deduction for federal income tax purposes. Consult with your tax advisers or the IRS to determine whether your contribution is deductible. If you have any questions, please contact [email protected]. Please refer to the privacy policy on our website as it governs the submission of information pursuant to this Agreement.

By submitting this form, I understand and accept the above terms.

Employee Payroll Deduction (U.S. Only)

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