Clemson Payroll Deduction
Name
*
First Name
Last Name
Department
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
IPTAY Number (If Applicable)
What payroll deduction action would you like to take?
*
New Deduction
Change Deduction
Stop Deduction
Annual Pledge Amount
Amount of deduction per check
Type Your Full Name To Authorize As Signature
*
By typing your full name, this will serve as your signature.
Authorization
*
*Type YES in the field above for authorization* I authorize a payroll deduction through Clemson University as indicated on this form from my first and second payroll checks each month as a gift to IPTAY. This authorization is to remain in effect until such time as I make written notification of a change or cancellation to IPTAY. I understand that I am responsible for any balance not covered by my payroll deductions.
Comments/Questions
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