HTML Preview Standard Payroll Deduction Form page number 1.
Payroll Deduction
F
o
rm
Please complete and return via campus mail
t
o
:
Wolfpack One Card Office
North Carolina State University
Campus Box 7307
Raleigh, NC 27695
Or by fax to:
(919) 515-7898
Permanent faculty and staff may authorize the Wolfpack One Card Office to activate his/her card to
allow monthly payroll-deducted charges through the AllCampus Network of service providers,
including University Dining locations, NC State Bookstores, Campus Cinema, Wolf Xpress Print & Copy
Service, Transportation, Ticket Central, College of Veterinary Medicine, and Carter-Finley Football
Concessions, and Lonnie Poole Golf Course Membership Fees.
Last Name First Name Middle Initial _____
University Dept/Box No
Campus ID Number Campus Phone Number
Home Address City State Zip
Pay Status Monthly Bi-weekly)
Note: Deductions will be taken from first b-iweekly paycheck of the
mon
t
h
.
I authorize the Wolfpack One Card Office to activate my ID Card to allow monthly payroll-deducted
charges from AllCampus network locations and allow these charges to be a combined monthly payroll
deduction from my regular salary up to the amount specified. I understand that I will be billed for any
charges that are unable to be deducted via payroll deduction.
Choose a Maximum Limit:
$50/month
$100/month
$150/month
$200/month
Signature (Please print and sign)
Date
To cancel your payroll
d
e
d
uc
t
i
o
n
,
please use this same form:
I wish to cancel my authorization. I understand that all charges made prior to this notification will still be
submitted as a payroll deduction.
Signature (Please print and sign)
Date