I authorize the Division of Facilities Management to initiate payroll deductions through the Payroll Deduction Program for my parking permit. I agree to have this deduction paid directly to The Division of Facilities Management by the State of Kansas through its Payroll Deduction Program.

I understand the deductions are voluntary on my part. I clearly understand that deductions toward the payment of my parking permit will be effective beginning the first full pay period following the signing of this agreement. I agree to pay the annual rate of $100.00 for the “permit required” parking lots. I am also aware that deductions will be taken bi-weekly (26 pay periods per year) of $3.85, regardless of how often I choose to park at the University of Kansas School of Medicine-Wichita. I also understand that the deductions affect only the price of the parking permit and exclude deductions of fines or any other outstanding debts to Facilities Management.

I understand there may be price increases and/or parking permit upgrades causing an increase in the scheduled deducted amounts.

If at any time I wish to stop my voluntary deductions or terminate employment with the University, I must notify Facilities Management in writing or email:wicfac@kumc.edu. In addition to the required written notification, I agree to return the parking permit to Facilities Management at which time parking privileges in the designated areas will cease. The payroll deductions for parking will cease in the two week pay period coinciding with the date Facilities Management receives the parking permit. If I do not return the parking permit after the payroll deduction has ended, I understand that I will be responsible for payment of the value of the permit while it is in my possession (whether used or not). If the permit is not returned, I will be responsible for the entire balance due. I understand any unpaid balance over 60 days past due will be collected by Facilities Management through the State of Kansas Set Off Program (K.S.A. 74-741).

I have read, understood, and agree to the terms of the Payroll Deduction Plan as described in this request and accept the responsibilities associate therewith.

By clicking the submit button you are creating a digital signature and agreeing to the terms and conditions of this application and the KUSM-W Parking Policies.