Payroll Deduction Gift - New Mexico State University
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1
2Join the Campaign for New Mexico State University
G I F T P A Y R O L L D E D U C T I O N A U T H O R I Z A T I O N F O R M
Name:
Aggie ID#:
Date:
Department:
Campus Mailing Address (MSC):
Campus Phone:
PLEASE CHECK ONE:
1
X
I currently have a payroll deduction for contribution and this request
replaces
my current deduction.
CONTRIBUTION
X
I currently have a payroll deduction for contribution and this request is in
addition
to my current deduction.
STATUS
INFORMATION
X
This is a
new
payroll deduction for contribution.
/
/
Begin date:
2
End date
PLEASE CHECK ONE:
CONTRIBUTION
X
Please deduct contribution until cancelled by me.
DATE
INFORMATION
/
/
X
Please end my deductions on (date):
(E-mail the Advancement Services Office, at giftacctg@nmsu.edu, to cancel gift deductions.)
PLEASE CHECK ONE:
I would like to contribute
per paycheck.
(Complete Column A and C in Step 4)
$
X
3
CONTRIBUTION
/
/
$
The total of
until (date)
(Complete Column B and C in Step 4)
X
INFORMATION
(For calculation assistance, please see back of this form)
(FOR ADVANCEMENT SERVICES)
Column A
Column B
Column C
Pay Period Amount
Total Contribution
Purpose For Which
Fund Number
NMSU (133) NMSUF (129)
Funds are to be Used
X
X
$
$
X
X
$
$
4
CONTRIBUTION
X
X
$
$
DETAIL
I hereby authorize NMSU to deduct from my pay the amounts as instructed above.
Signature: _____________________________________________________________________________________________________________
Thank you!
Your donation to support the Campaign for New Mexico State University
will make a difference in what this university can accomplish in the 21st century.
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