PAYROLL AUTHORIZATION FORM

LONESTAR FAMILIES FOUNDATION

PAYROLL AUTHORIZATION FORM

LONESTAR FAMILIES FOUNDATION

HELP SUPPORT FELLOW LONESTAR EMPLOYEES DURING TIMES OF UNEXPECTED HARDSHIP.

The Lonestar Families Foundation is a 501(c)(3) charitable organization that provides financial assistance to current employees facing qualifying medical emergencies, natural disasters, or other unexpected life events. Lonestar matches every employee payroll donation dollar for dollar. In 2025, the Foundation provided $192,000 in assistance to 40 Lonestar families.

Please Note:

Deductions are taken from after-tax pay each pay period.

Weekly employees contribute 52 times per year; semi-monthly employees contribute 24 times per year.

Deductions will begin with the next available payroll following submission. Individual contribution elections and amounts will not be shared with managers.

Payroll Deduction Authorization

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Your Name(Required)

Your Email Address(Required)

I Would Like To Contribute:(Required)

$1 Per Paycheck

$5 Per Paycheck

$10 Per Paycheck

$20 Per Paycheck

$50 Per Paycheck

Other: Indicate Amount

Other Amount

I voluntarily authorize 1155 Distributor Partners LLC dba Lonestar Electric Supply to deduct the amount selected above from each paycheck and remit it to the Lonestar Families Foundation. You may change or cancel your contribution at any time by contacting Human Resources at HR@LonestarElectricSupply.com. Donations are voluntary, non-refundable, and may be tax deductible.(Required)

Signature(Required)

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PAYROLL AUTHORIZATION FORM

LONESTAR FAMILIES FOUNDATION

PAYROLL AUTHORIZATION FORM

LONESTAR FAMILIES FOUNDATION

HELP SUPPORT FELLOW LONESTAR EMPLOYEES DURING TIMES OF UNEXPECTED HARDSHIP.

Payroll Deduction Authorization

Next Steps: Sync an Email Add-On

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