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Parking Plan Form

Parking/T-Pass Program - Section 132 (Qualified Transportation) Enrollment Form/Payroll Deduction Authorization

Full Name (including middle initial)*
Street Name *
City/Town *
State*
Zip Code*
Home Phone Number
Work Phone Number
Email*

*PARKING PLAN PROGRAM

YES, I choose to participate in the Parking Plan Program at Fisher College. I authorize Fisher College to deduct a total of $120.00* per month ($360.00* per quarter), from my paycheck for the quarter(s) I have indicated. I understand payroll deductions will be made in three monthly payments of $120.00 (if I am paid monthly) or in six equal payments of $60.00 (if I am paid biweekly). I also understand there are no partial payments.

I would like to sign up for the parking plan for the quarters indicated during the year 2012-2013:

     
   

*MONTHLY T-PASS/COMMUTER RAIL/BOAT PASS PROGRAM

YES, I choose to participate in the T-Pass program at Fisher College. I authorize Fisher College to deduct from my paycheck, the appropriate monthly amount(s) for the pass (es) I have selected for the months I have indicated. I understand payroll deductions will be made in one monthly payment (if I am paid monthly) or in two (2) equal payments per month (if I am paid biweekly). I also understand there are no partial payments and 30 days written notice is required for cancellation.

I would like to order the following pass (es) for the months indicated during the year 2012-2013:

     
     
     
     
    

New Option: 10 Ride Commuter Rail Tickets
     
     
     
    

Months:
     
     
     
     

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