Loyola University Chicago- Start Payroll Deduction

Start Payroll Deduction

I hereby authorize Loyola University Chicago to deduct my Halas Sports Center Membership fee in proportionate amount of money from my paycheck each pay period.

The current rate of deduction is vaild for the current fiscal year and is based on the current annual membership rate. Deductions will continue until requested to stop.

If you are creating a Family Membership, you will need to set up family members in person at the Halas Sports Center to get a Halas ID.

I understand the Halas Sports Center Membership fee will continue to be deducted until the stop deduction form is submitted.

Employee
First Name:

Last Name:

UVID:

Department:

Campus:

Home Phone:

Work Phone:

Effective Date:

Check the Appropriate Box	Payroll Schedule	Per Pay Period Deduction Amount	Number of Payments Annually	Annual Deduction
	Bi-weekly Individual	$12.08	26 Payments	$314.08
	Bi-weekly Family	$22.92	26 Payments	$595.92
	12 Months Individual	$26.17	12 Payments	$314.04
	12 Months Family	$49.67	12 Payments	$596.04
	9 Months Individual	$34.89	9 Payments	$314.01
	9 Months Family	$66.22	9 Payments	$559.98
Classification: Faculty Staff