Cell Phone Allowance Request Form printable pdf download

Furman University

Cell Phone Allowance Request Form

Date: _______________________________________________

Employee Name: _______________________________________________________

Employee ID: ___________________________

Paygroup: (please check one) ___Monthly ___Bi-Weekly

Job Title: ___________________________________________________

Department: _________________________________________________

Account #: _________________ Position Number (input by Finance): ____________________

Allowance Amount: $___________________ One-Time Equipment Payment: $___________

All cell phone allowance payments are departmental responsibility and considered other compensation charged to

object code ________. The cell phone allowance will start at the next scheduled monthly pay date.

Appropriate payroll taxes on the allowance amount will be withheld from the paycheck, and the amount of the

allowance will be included on the year-end W-2. The allowance does not constitute an increase to base pay, and

will not be included in the calculation of percentage increases to base pay due to annual raises, job upgrades,

bonuses, benefits based on a percentage of salary, etc.

Employee Certification and Signature:

I certify that I have read, understood, and intend to comply with Furman’s Cell Phone Policy.

Signature and Date ________________________________________________________

Supervisory Certification and Signature:

I certify that the requested cell phone allowance is needed for this employee and I have read, understood,

and intend to comply with Furman’s Cell Phone Policy.

Signature and Date ________________________________________________________

Please send completed form to

if you have any questions regarding the

policy.

Plan

Monthly Payment

One-Time Equipment*

100 minutes

$15

450 minutes

$45

Over 450 minutes

$75

Smartphone/PDA

$60

$200!

*The One-time equipment purchase is based on a 2 year contract and is provided at time of new contract

(documentation required). Lost or broken equipment will be the responsibility of the employee after initial

purchase.

Cell Phone Allowance Request Form