Payroll Deductions - Application Form

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Vehicle Information

Parking Payroll Deduction Authorization

I hereby authorize a monthly payroll deduction of the monthly pro rated share of the rates established by the Board of Governors for parking privileges to be deducted in accordance with accepted payroll program. I understand there is a one-time/non-refundable fee of $25 for the RFID hang tag.

Please Note: Parking is activated within 1-2 days of our receipt of this form. Parking charges begin the day after activation unless you notify us that you wish to begin parking on an alternate date. If you wish to specify an alternate date you MUST email Renee Varner at Parking passes are intended for the sole use of the OneCard holder only. Any “misuse” of parking privileges by employees could result in the loss of parking privileges and formal disciplinary charges.

Please also note that if you have cancelled your deductions in the current month, you cannot reinstate them until 30 business days have passed.

This authorization may be terminated by myself at any time by written notice filed with the OneCard/Parking Service Center. Reimbursement is effective the date the Cancellation Form is received by the Parking Office.