Employee Payroll Deduction Authorization Form - Middle Tennessee State University
Download a blank fillable Employee Payroll Deduction Authorization Form - Middle Tennessee State University in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Employee Payroll Deduction Authorization Form - Middle Tennessee State University with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1Employee Payroll Deduction Authorization
Development and Foundation Office
This is to authorize the Human Resource Services Office to make the following payroll deduction from my
monthly salary check as a contribution to the MTSU Foundation. I understand that I may discontinue my
deduction at any time by written notice.
The contribution on this form is
a new payroll deduction/contribution.
an additional contribution to the current contribution.
a change to the amount or designation of the current contribution.
a complete cancellation of the current contribution.
Direct my deduction to
Designated Fund
Designated Fund
Description
Number
Month/Year
Continue Deduction Until Notified
Monthly Deduction
Deduction to
(Y/N). If N, indicate month/year
Note: If you have a designation in mind but do
Amount
BEGIN
deduction should END
not know the description or fund number, please
call the Advancement Services Office at 898-5595.
Yes
No mo/yr._________
Yes
No mo/yr._________
Yes
No mo/yr._________
Total per
pay period
$0.00
Full legal name ____________________________________________________________________________
Home address ________________________________ City, state, zip ________________________________
Campus department____________________ Campus P .O. Box ________ Campus phone ______________
Campus e-mail address ___________________________________
Signature __________________________________________ Date __________________________________
Banner ID (M#) or last 4 digits of SSN: ___________________
Thank you for your support! Your contribution makes a tremendous impact. Please return this form
to the Advancement Services Office, Box 109. If you have any questions, please call 898-5595.
For Office Use Only
Date received __________________ Foundation Account No. ________________ Campaign code _________________________
Solicitation code: ______________________________
White copy–Advancement Services
Yellow copy–Human Resource Services
Pink copy–Payroll
Gold copy–Employee
MTSU, a Tennessee Board of Regents university, is an equal opportunity, non-racially identifi able, educational institution that does not discriminate against individuals with disabilities. UR072-0408
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business