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 am also aware that deductions will be taken bi-weekly (26 pay periods per year) 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.

My current parking permit color is Tan ($100.00) or Orange ($55.00) or Motorcycle ($40.00)

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 with the University, I am to notify Facilities Management and Payroll/Human Resources in writing. In addition to the required written notification, the parking permit is to be returned 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.

I further understand that this agreement does not constitute an extension of credit to me by the Division of Facilities Management.

I have read, understand, 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.