Fillable Authorization for Payroll Deduction (New Mexico Institute of Mining & Technology)

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Authorization for Payroll Deduction (New Mexico Institute of Mining & Technology)

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File type: PDF

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Authorization for Payroll Deduction
Name: _________________________
Banner ID#:
___________________
Home Address: ______________
Home Phone: ________________ Office Phone: __________________
E-mail address: ______________________________
Designation
A) I hereby authorize payments not to exceed $__________ , in equal amounts of $___________,for
the period beginning ________________ and ending __________________.
B) I authorize the deduction of the following amount $__________ each pay period until I notify
otherwise.
Dedu
ctions are designated to be deposited in the following account(s):
__ Children’s Center Endowment
__ President’s Club
__ President’s Golf Tournament
__ Music Department
__ Performing Arts Series
__ Other academic departments please specify: _________________________________
Employee Signature _____________________________________ Date___________________
Send form to, or contact: LaVern Robinson
Office for Advancement, 801 Leroy Pl, Socorro, NM 87801
(575)-835-5616 or lavern.robinson@nmt.edu
Approved by: _____________________________________________ Date:__________________________________
Form Updated: 9-24-2018
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Authorization for Payroll Deduction (New Mexico Institute of Mining & Technology)

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Completed 24 August 2020

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