GARBAGE PAYROLL DEDUCTION FORM
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
