ST. NORBERT COLLEGE
PAYROLL DEDUCTION AUTHORIZATION
I hereby authorize St. Norbert College to deduct from my salary the sum of ____________ , per pay
period, up to the sum of ____________ beginning ______________ . This deduction is for (check one
below):
Computer Loan Program - 124020
Custom Cash - 370020
Employee Payment on Account - 122700
I understand that upon termination of employment any balances owed to the college will be deducted
from my final pay check and if the final pay check does not cover the balance I will personally repay the
college.
Name (please print)
Signature
Employee I.D. Number
Date