UTA Payroll Deduction Request
UTA Payroll Deduction Request
I want to contribute monthly through the Payroll Deduction Program.
Monthly contribution
Monthly contribution




$







Check all that apply:
Check all that apply:







Change(s) in gift deduction amount or recipient fund/dept.
A change in gift deduction amount or recipient fund/dept. requires completion of this section.
Is this an addition to, or decrease in, a payroll deduction already in effect?
Is this an addition to, or decrease in, a payroll deduction already in effect?
$
$
I wish to keep my donation at the current level but change to a different recipient fund/dept:
I wish to keep my donation at the current level but change to a different recipient fund/dept: