Faculty/Staff Payroll Deduction Form
Faculty/Staff Payroll Deduction Form Season Ticket Package Faculty/Staff Ticket Kids (12 and under) Pavilion Club Pavilion Premium
HOCKEY
MEN'S BASKETBALL
WOMEN'S BASKETBALL
Ticket Total
$210 x ___ tickets $145 x ___ tickets $550 x ___ tickets $700 x ___ tickets
$50 x ___ tickets $40 x ___ tickets
$30 x ___ tickets $25 x ___ tickets
$________ $________ $________ $________
TOTAL TICKET COST
$________
I hereby request and authorize the University of Massachusetts Lowell to withhold from my pay an amount up to the Total Ticket cost noted above. Payroll deductions are scheduled to be withheld from a minimum of six (6) pay dates (10/20/17 – 12/29/17) and a maximum of thirteen (13) pay dates (7/14/17 – 12/29/17). The number of deductions is determined by the date the form is fully executed by the Tsongas Center Box Office.
FACULTY/STAFF PAYROLL DEDUCTION DEADLINE IS WEDNESDAY, SEPTEMBER 13, 2017 Employee Name: __________________________________________ Employee #: ___ ___ ___ ___ ___ ___ ___ ___ Contact Phone Number: ____________________________ UML Email Address: ______________________________ Please mail my season tickets to the following address: Address: ________________________________________________________________________________________ City: _______________________________________________________ State: _____________ Zip: ______________ I understand that I may not revoke this election after submission and that compensation reduction amounts are NOT REFUNDABLE. Signature: ______________________________________________________ Date: _______________ (mm/dd/year)
Please mail completed Faculty/Staff Payroll Deduction form to the Tsongas Center Box Office. Forms must be received no later than Wednesday, September 13, 2017. Tsongas Center Box Office, 300 Martin Luther King Jr. Way, Lowell, MA 01852 www.goriverhawks.com P: 978-934-5738 F: 978-934-5743
FOR DEPARTMENT USE ONLY
Date HR/Payroll Received: Circle Effective Date
Above Ticket Total Deposit/Credit Amount
$ _________ – _________
Total Amount Owed
$ _________
Number of Deductions Bi-Weekly Deduction Amount Deduction End Date
_______ $__________ __12/23/2017
Effective Date Pay Date 6/25/2017 7/14/2017 7/9/2017 7/28/2017 7/23/2017 8/11/2017 8/6/2017 8/25/2017 8/20/2017 9/8/2017 9/3/2017 9/22/2017 9/17/2017 10/6/2017 10/1/2017 10/20/2017
Deductions 13 12 11 10 9 8 7 6
HOCKEY
MEN'S BASKETBALL
WOMEN'S BASKETBALL
Ticket Total
$210 x ___ tickets $145 x ___ tickets $550 x ___ tickets $700 x ___ tickets
$50 x ___ tickets $40 x ___ tickets
$30 x ___ tickets $25 x ___ tickets
$________ $________ $________ $________
TOTAL TICKET COST
$________
I hereby request and authorize the University of Massachusetts Lowell to withhold from my pay an amount up to the Total Ticket cost noted above. Payroll deductions are scheduled to be withheld from a minimum of six (6) pay dates (10/20/17 – 12/29/17) and a maximum of thirteen (13) pay dates (7/14/17 – 12/29/17). The number of deductions is determined by the date the form is fully executed by the Tsongas Center Box Office.
FACULTY/STAFF PAYROLL DEDUCTION DEADLINE IS WEDNESDAY, SEPTEMBER 13, 2017 Employee Name: __________________________________________ Employee #: ___ ___ ___ ___ ___ ___ ___ ___ Contact Phone Number: ____________________________ UML Email Address: ______________________________ Please mail my season tickets to the following address: Address: ________________________________________________________________________________________ City: _______________________________________________________ State: _____________ Zip: ______________ I understand that I may not revoke this election after submission and that compensation reduction amounts are NOT REFUNDABLE. Signature: ______________________________________________________ Date: _______________ (mm/dd/year)
Please mail completed Faculty/Staff Payroll Deduction form to the Tsongas Center Box Office. Forms must be received no later than Wednesday, September 13, 2017. Tsongas Center Box Office, 300 Martin Luther King Jr. Way, Lowell, MA 01852 www.goriverhawks.com P: 978-934-5738 F: 978-934-5743
FOR DEPARTMENT USE ONLY
Date HR/Payroll Received: Circle Effective Date
Above Ticket Total Deposit/Credit Amount
$ _________ – _________
Total Amount Owed
$ _________
Number of Deductions Bi-Weekly Deduction Amount Deduction End Date
_______ $__________ __12/23/2017
Effective Date Pay Date 6/25/2017 7/14/2017 7/9/2017 7/28/2017 7/23/2017 8/11/2017 8/6/2017 8/25/2017 8/20/2017 9/8/2017 9/3/2017 9/22/2017 9/17/2017 10/6/2017 10/1/2017 10/20/2017
Deductions 13 12 11 10 9 8 7 6
