Voluntary Parking Garage Pass Pre-Tax Payroll Deduction Request

Name: 		WCU ID#:  	

E-mail Address:  	

•	 New Street Garage   	r Sharpless Street Garage 
7517023515                                                                   7517013515 

•	One Semester ($130.00)

I hereby authorize West Chester University to withhold from my wages the total pre-tax amount of
$ 	, which shall be divided over the number of pay period(s) I receive per semester (or annually for the annual pass), for the purpose of purchasing a parking pass for the Parking Garage.

I understand that should my employment with West Chester University end my parking privileges will expire at the close of business on the last day of my employment, and I am responsible for returning my pass to the WCU Parking Services Office directly.

I understand that I can relinquish this parking pass at any time but I will be charged the full amount for the pay period regardless of when I turn in the pass during that pay period. 

This authorization is executed voluntarily and has not been made as a condition of my continued employment.

NOTE: This parking pass is assigned to you and is not transferable. You are not permitted to lend or share this pass with anyone else. Employees found to be in violation of university parking regulations may be subject to revocation of parking privileges.

Signature	Date

Parking Services Use Only Permit #:  	  Assigned by:  	
Date:  	

Payroll Use Only

SAP ID#:  	
Biweekly Rate:  			 Initials: 		Date: