Annual Fund Faculty/Staff Payroll Deduction Form
*= TOTAL amount

*Amount from each paycheck:

*How many paychecks do you want the above amount deducted?

*NAME:
*HOME ADDRESS:
*CITY:
*STATE:
*ZIP CODE:
TELEPHONE #:

*GOTHIC ID:
*EMAIL ADDRESS:
By hitting FINISH and submitting this form to the Office of Development and the Payroll Office, I am authorizing deductions to be taken from my pay checks as indicated above.
Hard copies of this form are available by calling Lori Summers at (201) 200-3489, or emailing her at lsummers@njcu.edu.