Payroll Deduction Form

For Faculty and Staff at SUNY Plattsburgh

Count Me In Payroll Form

I would like to Required Field

I would like to Start a payroll deduction
Increase my current payroll deduction amount

Total deduction amount per pay period Required Field

Designation Required Field

Designation The Plattsburgh Fund
Other

Memo

First Name Required Field

Last Name

Address Line 1

Address Line 2

City

State

Zip

Banner ID

Authorization Check Box Required Field

By checking the above authorization check box, I understand that this form authorizes SUNY Plattsburgh Payroll to withhold from my salary and/or wages for the designated amount per pay period. This form overrides existing payroll donation deductions to the SUNY Plattsburgh College Foundation. All fund deductions must be indicated on this form and will occur each pay period until the foundation is notified in writing of a change.