Agreement for Preauthorized Benefit Premium Payments

A retired University of Michigan employee may have benefit premiums automatically withdrawn from a checking or savings account by completing the attached form and sending it to:

Payroll Office
1000 Victors Way
Ann Arbor, Michigan 48108

FAX: (734) 647-3983

Please contact the Human Resources & Payroll Service Center at (734) 615-2000 or toll free at (866) 647-7657 with any questions.