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Garbage Payroll

UNIT NUMBER          ­­­         ___________________________
EMPLOYEE NAME             ___________________________
BANNER NUMBER            ___________________________
I hereby authorize the University of the South to deduct my share of the Sewanee Community Garbage Service fee, currently $22.00 per month, effective July 1, 2012 from my pay in equal installments beginning with the first payroll on _______________.
The fee is subject to change each fiscal year and I understand that I will be notified prior to July 1st of each year of the amount due for the next fiscal year (July 1 – June 30th)
This payroll deduction authorization will remain in force as long as I am eligible to pay by way of payroll deductions.
____________________________________      _________________
Signature                                                                 Date
Return completed form to:
Laurie Kianka
Rental Housing Administrator
735 University Avenue
Sewanee, TN 37383
CC: Debbie Ladd

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Sewanee: The University of the South735 University Ave, Sewanee, TN 37383931.598.100035.204826-85.921674