Sales Associate Donation Enrollment Form
(Please print and complete the entire form.)
The undersigned agrees to deduct voluntary contributions to the Coldwell Banker Burnet Foundation from
their commission check. These funds will be held by the Foundation until it is deemed appropriate to donate.
The donation will be to a public charity or other 501(c)(3) organization at the request of Coldwell Banker
Burnet Foundation’s Advisory Committee.
I request that $______________be deducted per side of a closed transaction from my commission check
(includes both sales and referrals). Your voluntary automatic deduction may be elected at a minimum of $5,
in $5 increments.
For example: If you are on the listing side and selling side of a transaction and request $25.00 be deducted
we will deduct a total of $50.00. We will deduct $25.00 per side.
Choose one of the following:
The maximum amount I want deducted per year is $______________.

There is no maximum amount per year.
Deductions will begin as soon as this request is forwarded to payroll/commissions. The renewal is
automatic each year. If you wish to stop this deduction, complete the Cancellation Form found in Toolbox
and submit to Teresa Taylor. Cancellations will be processed as soon as possible.
You will receive an annual contribution letter for tax purposes.
Name:_________________________
Office______________________
Signature:______________________
Date:______________________
Address:_________________________________________________________
Choose one of the following:
Please keep my name confidential, and do not include my name on marketing materials
regarding the Foundation and Automatic Donation.
My name may be used in marketing materials regarding the Foundation. My amount contributed
will remain confidential.
Send this completed form via interoffice mail to Teresa Taylor, Coldwell Banker Burnet Corporate
Office, or mail it to Teresa Taylor at 7550 France Avenue South, Suite 300,
Edina MN 55435, or fax it to 952-844-6444.
Please keep a copy for your records.