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Get Payroll Deduction Gift Form - The University Of Texas At Dallas

Ve questions, call ext. 2295. Donor Name: UTD ID: Department/Office: Home Address: Title: Work Phone: Home Phone: Work Email: Home Email: I am (check all that apply): Faculty I want to contribute: $ Staff X Amount Per Pay Alumni my total gift $ . # of Pay Periods Designate my gift to: Begin my payroll deduction on this date: I hereby authorize The University of Texas at Dallas to deduct from my paycheck each pay period the amount indicated above. Donor Signature: NOTE: Your con.

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