Airius Airway's 401k Contributions Worksheet (Sample Only)

Employee Name	Social Security Number
	--

Fund Options	Monthly Contribution
	%
	%
	%
	%
	%
After specifying your monthly contribution, (You may contribute to as many funds as you like) submit this form. You will receive email confirming your choices. Airius Contributes $0.50 for every $1.00 you contribute. All dollars you contribute are deducted from your salary before taxes.