Our process requires us to obtain your authorization prior to any payroll deduction. Please complete the form below and indicate your acceptance with your signature. We will forward your authorization to your payroll department to complete the request.
SALARY RANGE | ANNUAL | 10 MONTH PAYROLL DEDUCTION | 12 MONTH PAYROLL DEDUCTION |
|---|---|---|---|
$0 – $99,99 | $320.76 | $32.08 | $26.73 |
$100,000 – $149,999 | $385.56 | $38.56 | $32.13 |
$150,000 – $199,999 | $466.56 | $46.66 | $38.88 |
$200,000 and over | $660.96 | $66.10 | $55.08 |
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