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VOLUNTARY PAYROLL DEDUCTION FORM

This plan is renewable. Once you sign this consent form for deductions, it will automatically renew the following year. It is voluntary, after-tax deduction. The payroll deduction can be changed or stopped at any time by contacting Payroll Group.

I AUTHORIZE MY EMPLOYER TO DEDUCT THE ABOVE AMOUNT FROM MY PAYCHECK AS A VOLUNTARY, CHARITABLE CONTRIBUTION TO HOPE TO DREAM, A REGISTERED 501(C)(3) CHARITABLE ORGANIZATION. I UNDERSTAND THIS VOLUNTARY DEDUCTION WILL BEGIN IMMEDIATELY AND CONTINUE UNTIL I NOTIFY PAYROLL GROUP IN WRITING THAT I NO LONGER WISH TO DONATE TO HOPE TO DREAM.

Hope to Dream believes that every child deserves a good night’s sleep. Founded in 2010 on that guiding principle, Hope to Dream is an all-volunteer non-profit organization that provides beds to children in need across the U.S. and Canada. A portion of the proceeds for every mattress purchased at a participating Ashley HomeStore helps pay for a bed for an underserved child. Since its inception, more than 100,000 children have received a brand new bed. For more information on Hope to Dream, please visit

www.AHopetoDream.com

We are pleased to offer easy and convenient payroll deductions as a means for you to be able to contribute to the Hope to Dream charity. The minimum contribution is $1.00 per paycheck.