The University of Mississippi s4

The University of Mississippi ID Center: Room 155 Johnson Commons West P.O. Box 1848 University, MS 38677 ID Center: (662) 915-7423 Fax: (662) 915-7335 Email: [email protected] Dining Services: (662) 915-6690 OleMissDining.com Faculty/Staff Payroll Deduction Form

Name (print): ______Personnel Number (not SSN):______

Daytime Phone (if emailing or faxing request):______

Check Here: Faculty/Staff 25: $185 - 25 all-you-care-to eat meals at the Rebel Market, Marketplace at the Residential College, the Grill at 1810, and breakfast only at McCormick Café - Meals never expire, $7.40 per meal, taxes included - Meals work at the Grill at 1810 for dinner, but in addition to a meal, they require an additional upcharge. An additional meal may be used for the dinner upcharge. Please choose payroll deduction: _____ 2 installments or _____ 4 installments Faculty/Staff 50: $350 - 50 all-you-care-to eat meals at the Rebel Market, Marketplace at the Residential College, the Grill at 1810, and breakfast only at McCormick Café - Meals never expire, $7.00 per meal, taxes included - Meals work at the Grill at 1810 for dinner, but in addition to a meal, they require an additional upcharge. An additional meal may be used for the dinner upcharge. Please choose payroll deduction: _____ 2 installments or _____ 4 installments Faculty/Staff 100: $675 - 100 all-you-care-to eat meals at the Rebel Market, Marketplace at the Residential College, the Grill at 1810, and breakfast only at McCormick Cafe - Meals never expire, $6.75 per meal, taxes included - Meals work at the Grill at 1810 for dinner, but in addition to a meal, they require an additional upcharge. An additional meal may be used for the dinner upcharge. - Please choose payroll deduction: _____ 2 installments, _____ 4 installments, or _____ 6 installments Ole Miss Express Please note: No Express deposits will be added by payroll deduction for the month of December because of the holiday payroll schedule. The maximum monthly deposit by payroll deduction for Express is $150. Amount: $______Deducted equally from 2 paychecks.

I understand that I am requesting a payroll deduction for the selected Faculty/Staff Meal Plan and/or Ole Miss Express Dollars. This payment will be deducted as stated above. Signature: ______Date: ______

______For Office Use only______**Employment with The University of Mississippi has been verified in SAP ______(initials)** ______Meals added @ $ ______on ____/____/____Processed By: ______(initials) ______Ole Miss Express Dollars added @ $ ______on ____/____/____Processed By: ______(initials) Uploaded To Payroll Deduct on: _____/_____/_____Processed By: ______(initials)