VT Payroll Deduction Form

Virginia Tech Athletic Fund
Payroll Deduction Form

Please return completed form to:

Virginia Tech Athletic Fund
P.O. Box 10307
Blacksburg, VA 24062
Virginia Tech Athletic Fund
P.O. Box 10307
Blacksburg, VA 24062

This form is to be used by
Virginia Tech Employees only.

I wish to contribute $_____________________ annually to the Virginia Tech Athletic Fund through the

Payroll Deduction Plan. Please deduct $_______________ per month beginning:

____________ Month,	________ Year	*and ending*	____________ Month,	________ Year

(Note: 12 monthly payments should equal the annual contribution. You may make this form valid for more than one year if you do not wish to renew it each year.)

I would like to designate my gift for the Virginia Tech Athletic Fund for

Unrestricted

______________________________(Specify use)

Please print full name:______________________________________

Signature:__________________________________________________

Home Address:__________________________________________________________________________

Work Phone Number:_________________________ Home Phone Number:_________________________

Thanks for your support of the Virginia Tech Athletic Fund!