Employee Payroll Deduction Form November 16 – December 8 Name First Last Employee NumberHiddenProduct NameRaffle TicketNumber of EntriesTotal Donation Consent By completing this form and entering my name and ID number, I hereby authorize Associated Grocers, Inc. to withhold from my wages the total amount entered for the iPad Mini 2 Raffle. Payroll deductions will take place the week of December 11th.CAPTCHACommentsThis field is for validation purposes and should be left unchanged. Δ