VOL CHECK-OFF CARD PLEASE ENCLOSE A VOIDED CHECK OR DEPOSIT SLIP Name :__________________________________________________________ Address :_______________________________________________________ City :_____________________ State :_____________ Zip :__________ Home Phone :_______________ Business Phone :____________________ Social Security Number :________________________________________ Month to Start Draft :__________________________________________ Amount (monthly) :______________________________________________ Bank Name :_____________________________________________________ Location :(City)___________________(State)______________________ [] Checking [] Savings (Check one) Account number :________________________________________________ FOR OFFICE USE ONLY: Bank transit Number :______________________ I authorize The University of Tennessee at Knoxville to deduct my monthly VASF payment from my checking/savings account and to make that mount payable to the order of The University of Tennessee and to credit that amount to my VASF account. In making this authorization, I agree to all terms at the bottom of this authorization. Signature :_____________________ Date :_________________________ I authorize the financial institution named above to pay my monthly VASF payment and to deduct each payment from my checking of savings account. I agree that each payment shall be the same as if it were a check personally signed by me. This authority is to remain in effect until revoked by me in writing. In addition, I have the right to stop payment or a charge by a timely notification to the VASF Department at The University of Tennessee prior to changing my account. I understand, however, that both my financial institution and/or The University of Tennessee reserve the right to terminate this payment plan (or my participation therein). Mailing Address: University of Tennessee Athletic Development Office P.O. 15016 Knoxville, TN 37901-5016 Phone: (423) 974-1218 Make Checks Payable to: The University of Tennessee