2017 Football Season Tickets BGSU Faculty and Staff Payroll Deduction Form Please complete this form and return the signed copy to the BGSU Ticket Office in the Stroh Center, or mail to BGSU Ticket Office, 1535 East Wooster Street, Bowling Green, OH 43403. ACCOUNT #:
BGSU ID #:
LAST NAME:
FIRST NAME:
HOME ADDRESS:
CITY:
STATE:
ZIP:
BGSU EMAIL:
CAMPUS PHONE:
EMPLOYMENT STATUS:
□ FACULTY □ ADMINISTRATIVE □ CLASSIFIED
BGSU Athletics is offering current BGSU Faculty/Staff ONE free season ticket on the East side of Doyt Perry Stadium. You may upgrade your ONE free East side ticket to a West side Chairback and pay only $30 on that one seat. You may also upgrade your ONE free East side ticket to a West side Bench and pay only $15 on that one seat. ^As a benefit of being a Falcon Club member or a season ticket holder in sections 13 or 15, individuals will receive one free parking pass for the 2017 Football Season. If you are not a Falcon Club member and would like to purchase a parking pass, please fill out the column in the table and add it to your total.
SPLIT PAYMENTS INTO:
□ 4 PAYMENTS □ 6 PAYMENTS □ 8 PAYMENTS
Seating Category East (1 Free) East Additional Falcon Four Pack East Side (Min. 4 Tickets) Falcon Four Pack West Side (Min. 4 Tickets) West Bench Upgrade West Bench Additional West Chairback Upgrade West Chairback Additional West Premium Bench* West Premium Bench Additional* West Premium Chairback* West Premium Chairback Additional* Season Parking Pass^
Season Quantity Price Free $60 $40 $45 $15 $70 $30 $80 $15 $70 $30 $80 $50 Processing Fee
TOTAL
$10.00
Total *Requires an additional per-seat donation to the Falcon Club
Funds will be withdrawn from your paycheck beginning in the month of August 2017. If you have any questions, please call the ticket office at 419-372-0000 or email
[email protected] Authorization Agreement I authorize BGSU to deduct from my earnings the total cost of my purchase of 2017 BGSU football season tickets in the amount described under “Total” above. If my employment with BGSU should terminate for any reason before the said amount has been paid in full, I hereby authorize BGSU to deduct the full amount then-remaining due and owing on my purchase from my final BGSU paycheck.
By signing this form, I certify that I have read, fully understand and authorize the above payroll deduction. SIGNATURE:
DATE:
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