Child Care Center Payroll Deduction Authorization

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Child Care Center
Payroll Deduction Authorization
This form is used only to initiate or change payroll deductions to pay for the cost of child care at the University’s Child
Care Center. Please be advised that this is not a pre-tax deduction program.
New Deduction
Change Deduction
Terminate Deduction
Employee Name:
____________________________________________________________________
Banner Number: _________________
Child’s Name: _______________________________________________________________________
Deduction Amount:
One Time Deduction of $ ____________________________
Biweekly Deductions
Biweekly Amount: $ ___________________
Number of Deductions: ________________
Total Amount to be Withheld: $ __________________________
I hereby authorize William Paterson University to make the above deductions for my paycheck(s).
_______________________________________________________
___________________________
Signature
Date

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