4R Family Fund

All 4 Rivers team members can contribute to the 4R Family Fund through automatic payroll deductions that occur on a bi-weekly basis, according to the amount designated below, or on a one-time basis whenever elected by a team member.

Name(Required)

First Last

Location(Required)

OPTION A: BI-WEEKLY RECURRENT CONTRIBUTION

I hereby authorize 4R Restaurant Group, LLC and/or its affiliates (the “Company”) to deduct, from my bi-weekly wages, the amount designated below and to contribute it to the 4R Family Fund, effective immediately*.

Specify Other Amount(Required)

OPTION B: ONE-TIME CONTRIBUTION

I would like to make a one-time contribution. I authorize the Company to deduct this amount from my next paycheck dated and contribute it to the 4R Family Fund.

I understand that my bi-weekly or one-time contribution to this voluntary fund will be used as assistance to 4 Rivers team members who experience a need that is consistent with established guidelines for qualifying events under the 4R Family Fund policy and program. I further understand that I may revoke this authorization at any time by submitting written notification of my desire to cancel the contribution to payroll@4rsmokehouse.com. In the event that my contribution cannot be withheld from my paycheck, no additional contribution will be taken the following paycheck.(Required)

Yes I Understand

4R Family Fund Contribution

Authorization Form

4R Family Fund

Links

4 Rivers Family