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Payroll Deduction Authorization

1. Deduction type
*
2. Total to be deducted from each paycheck
*
3. Designation(s)
*
4. First Name
*
5. Last Name
*
6. Employee number
*
7. Address
*
8. City
*
9. State
*
10. Zip
*
11. Email address
*
12. Additional Comments

ECSU

 

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Connecticuts Public Liberal Arts University
83 Windham Street, Willimantic, Connecticut 06226