Fillable Payroll Deduction Form Oct 17

Fill Online, Printable, Fillable, Blank Payroll Deduction Form Oct 17 Form

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Payroll Deduction Form Oct 17

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Advancement Services Revised 10/17
TENNESSEE TECHNOLOGICAL UNIVERSITY
GIFTS TO THE TTU FOUNDATION
Authorizaon for Payroll Deducon
I wish to contribute to the University in the following area(s). Each month please deduct the amount(s) indicated from my payroll
check. (For informaon or assistance call Ext. 6102.)
Duraon (inclusive)
Designaon
Monthly Amount
1. __________________ _____________________________________________ Start:___________________ _______
Other ________________________________________ End:___________________ ________
2. __________________ _____________________________________________ Start:___________________ _______
Other ________________________________________ End:___________________ ________
3. __________________ _____________________________________________ Start:___________________ _______
Other ________________________________________ End:___________________ ________
4. __________________ _____________________________________________ Start:___________________ _______
Other ________________________________________ End:___________________ ________
I wish to terminate all previous forms for gis to TTU Foundaon by payroll deducon(s).
Please stop all payroll deducons for gis to the TTU Foundaon as of __________________ _______.
I understand that this form must be received in the Gis/Records and Stewardship Center by the 5th of the month to begin OR
end deducons during the same month.
Clear Form Print Form
___________________________________________________ __________________________________________________
Employee Printed Name Employee Banner T-Number
___________________________________________________ __________________________________________________
Employee Signature/Date Campus Phone/TTU Box Number
___________________________________________________
Vice President for University Advancement Signature Date
Please return this completed document to University Advancement, Box 5111; a copy will be retained there and the original
will be forwarded to Payroll.
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Payroll Deduction Form Oct 17

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Completed 22 March 2020

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