By submiting this form, you authorize the above deduction from my paycheck as a charitable contribution to St. Elmo Steak House, Harry & Izzy's, 1933 Lounge and HC Tavern + Kitchen's Fork Over Change benevelence program. If I selectred a recurring payroll deduction, I understand that this deduction will continue until I request a change or stop to the deduction, and that I must submit a written request at least two weeks in advance of the desired change or stop date. I understand tha my donation is not tax deductible..