I hereby authorize Juniper to process the deduction selected above from my paycheck as a voluntary contribution to the Juniper Cares Employee Relief Fund and acknowledge the following:

• I understand my contributions will be deposited and used for purpose of the Juniper Cares Employee Relief Fund.
• I understand refunds will not be issued on any contributions processed.
• I understand to stop a recurring deduction at any time I must submit a request in writing to the Juniper Cares Employee Relief Fund email at caresfund@juniperlandscaping.com.
• I understand requests to stop or start a recurring deduction will be processed in the pay period following the date requested.

By submission of my application for consideration, I certify that the information in this application is true, complete, and correct. I understand that false answers, statements, or significant omissions made by me shall be sufficient cause for denial of assistance and corrective action. Should my request be approved, I agree to the terms set-forth in this application and related policies and procedures.