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					                                                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:                         TOTAL AUTHORIZED DEDUCTION
                            O $100.00 O $200.00 O $500.00 O $1000.00                     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                                                                              SOCIAL SECURITY NO.
O CO-OWNER
O BENEFICIARY
STREET ADDRESS                                                           CITY & STATE                      ZIP CODE


                                                                         CHANGE DEDUCTION
THIS PART PERTAINS TO CHANGES ONLY →                                     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