Payroll Savings – Series EE Savings Bond Application
A savings bond costs one-half of its face value. Any amount can be used for payroll deduction provided that it takes no more than
10 pay periods to complete the purchase of a bond. Excess deductions will be applied to the future purchase of a bond.
EFFECTIVE DATE
U.S. SAVINGS BOND IN DENOMINATION OF:
O $100.00 O $200.00 O $500.00 O $1000.00
TOTAL AUTHORIZED DEDUCTION
PER PAY PERIOD: $
REGISTER SECURITIES AS FOLLOWS
OWNER (FIRST, MIDDLE INITIAL, LAST)
SOCIAL SECURITY NO.
STREET ADDRESS
CITY & STATE
ZIP CODE
FIRST, MIDDLE, INITIAL , LAST
O CO-OWNER
O BENEFICIARY
SOCIAL SECURITY NO.
STREET ADDRESS
CITY & STATE
ZIP CODE
THIS PART PERTAINS TO CHANGES ONLY →
CHANGE DEDUCTION
From: $
To: $
This authorization for deduction from my paycheck cancels any previous authorization. This authorization will continue in effect until cancelled by
me in writing, or termination of my employment, or termination of the offering of these securities.
SIGNATURE OF EMPLOYEE (PURHASER)
CAMPUS
DELIVERY DROP
DATE
Complete form and return to: Research Payroll Services Room 101 Jacobsen Hall