EASTERN MICHIGAN UNIVERSITY
PAYROLL DEDUCTION AUTHORIZATION OR CANCELLATION
STUDENT BUSINESS SERVICE TUITION/LOAN
I herby authorize the following deduction from my payroll checks and the remittance of this deduction to the indicated
agencies.
EMPLOYEE # DED. CODE
______________________________________________________________________________________________________________________________________________________________________________ ________________________________________ ___________________________________________________________________________________________________________________________________________________________________________________________________________
(Completed by SBS)
NAME DED. AMT $
______________________________________________________________________________________________________________________________________________________________________________ ________________________________________ ___________________________________________________________________________________________________________________________________________________________________________________________________________
(Last name first-please print)
DATE GOAL $
______________________________________________________________________________________________________________________________________________________________________________ ________________________________________ ___________________________________________________________________________________________________________________________________________________________________________________________________________
SIGNATURE ACCT #
______________________________________________________________________________________________________________________________________________________________________________ ________________________________________ ___________________________________________________________________________________________________________________________________________________________________________________________________________
SBS Approval ACCT NAME
______________________________________________________________________________________________________________________________________________________________________________ ________________________________________ ___________________________________________________________________________________________________________________________________________________________________________________________________________
(Approval required from SBS before Payroll can process)
Send to: Student Business Services 204 Pierce Hall REFERENCE #
___________________________________________________________________________________________________________________________________________________________________________________________________________
SBS will forward original to Payroll and will keep copy. (Completed by SBS)
de: 10/8/08
