UNIVERSITY OF DELAWARE
2015-2016 FACULTY/STAFF CARPOOL PERMIT PAYROLL DEDUCTION AUTHORIZATION
NAME (print clearly)
______________________________________________
CAMPUS ADDRESS OR DEPARTMENT
_______________________________________________
UD ID NUMBER
_______________________________________________
VEHICLE INFORMATION:
STATE _____ VEHICLE PLATE # ______________ MAKE _________________ MODEL ______________ COLOR ___________
STYLE (circle one): 2 Door
4 Door
Truck
Minivan
SUV
Convertible
INDICATE PAY TYPE - SALARIED/SEMI-MONTHLY _____ HOURLY/BI-WEEKLY _____
DEDUCTION SCHEDULE - CHECK ONE (1) ONLY
PRE-TAX Deductions:
____ BOTH PAYS
____ FIRST PAY ONLY
____ SECOND PAY ONLY
AFTER TAX deductions:
____ BOTH PAYS
____ FIRST PAY ONLY
____ SECOND PAY ONLY
I hereby authorize the University of Delaware to deduct the amount indicated below from my salary/wage checks between
September 2014 and August 2015 in payment of parking permit fees, unless terminated earlier by written notification. If so
terminated, the permit becomes null and void and it is to be returned to Parking Services.
Signature_____________________________________________________
***Check only one (1) carpool & deduction option from below (all permits are annual permits)
2 members
1 member deduction
2 members
per person deduction
3 members
per person deduction
Gray North
____ $ 416.00
____ $ 208.10
____ $ 124.80
Gray East
____ $ 416.00
____ $ 208.10
____ $ 124.80
Central
____ $ 534.00
____ $ 267.00
____ $ 160.20
Pearson
____ $ 567.00
____ $ 283.50
____ $ 170.10
____ $ 590.00
____ $ 295.00
____ $ 177.00
Central Gate - Lot 34C, 53C
____ $ 700.00
____ $ 350.00
____ $ 210.00
Central Gate - Lot 21, 35C, 37C
____ $ 719.00
____ $ 359.50
____ $ 215.70
Gate/Garage
(4C, 14C, 17C, 20C)
When both carpool vehicles are on campus at the same times, a daily scratch off pass must be displayed on the second vehicle.
Gray and 20C permits get gray scratch off passes
Central, Central Gate and Garage permits get central scratch off passes
Lot 53 and Gate Lot 53C permits get lot 53 scratch off passes
WHEN RENEWING GATE-CONTROL, INDICATE: LOCATION (LOT#) ___________________
Parking Office only: Permit No.__________ Date __________ Initials _______
Rev. 6/15 dp