Page 1 4/3/2018 South Carolina State University POST OFFICE BOX 7511 300 COLLEGE STREET, NORTHEAST ORANGEBURG, SOUTH CAROLINA 29117 (803) 536-8579

ATHLETICS TICKET OFFICE FAX: (803) 533-3631

Payroll Office SC State University Post Office Box 7716 Orangeburg, South Carolina 29117-0001

This form gives the SC State University Payroll Office authority to deduct the following from my earnings as a university employee. The “per-pay period” amount will be made payable to the SC State University Ticket Office for 2011 Football Tickets and/or Season Parking.

The deadline to sign up for Payroll Deduction is June 30, 2011. All payroll deductions will begin on July 15, 2011 and will end on September 15, 2011.

Name: ______ID#: 9000______Department: Campus Extension: ______Check One: Faculty ______Staff ______Deduction Amount: Total amount: $ Per-pay period amount: $ Deduction Schedule: Beginning Date: July 15, 2011 Ending Date: September 15, 2011

Signature: Date:

Please return this form along with your ticket application form to: SC State Ticket Office Campus Box 7511 Orangeburg, SC 29117

Ticket Office Approval: FOR TICKET OFFICE USE ONLY Date:

Tickets Purchased:

Parking Purchased:

Approved By: Date: