Payroll Deduction Form - Giving To Mit printable pdf download

Payroll Deduction Form - Giving To Mit

MIT EMPLOYEE PAYROLL DEDUCTION GIFT FORM

Please mail completed form to:

MIT Office of the Recording Secretary

Phone: 617-253-5048

Payroll Deduction Gift Program

Fax: 617-258-8316

600 Memorial Drive, Third Floor

E-mail: RecSec@mit.edu

Cambridge, MA 02139

Name: ____________________________________________________________

Work Address: ______________________________________________________

Work Phone: _______________________ Email: __________________________

I want to contribute the following amount each pay period:

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$10

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$25

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$50

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Other $______________

Number of pay periods I wish to contribute:

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Monthly (12)

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Weekly (52)

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Other: _____________________

My total payroll deduction gift is: $____________________________

*Start Date: _____________________

End Date: ________________________

Designate my gift to: ____________________________________________________

I authorize CAO to deduct from my payroll the stated amount listed above:

Signature:___________________________ MIT ID Number:__________________

Date:____________________________

*After form is submitted, please allow 30 days for processing before deductions begin.

Payroll Deduction Form - Giving To Mit