Payroll Deduction Request

For Summer 2018

**NOTE: All Information is Required

Your Name
     First Name      Last Name
   Duke Unique ID   Telephone Number
   Email Address   Re-Type Email Address

 Total amount for Summer 2018 term to be deducted:
    $ (minimum $450)

Note: Total amount will be equally divided over 3 deductions. Summer 2018 deductions will be taken in May, June, July if your request is received by May 7, 2018. Requests received between May 8, 2018 and June 4, 2018 will be taken in June and July. Deduction requests for summer term will not be accepted after June 4.

 Pay Date(s):


 Additional Information or Comments:

 Please type this verification code in to the below box:   63877



By submitting this form I authorize the Bursar's Office to make payroll deductions for the total amount and time period shown on the form above. I have read and agree to abide by the terms and conditions. Enrollment is subject to approval by the Bursar's Office.