Payroll Deduction Approval Form

VIEWS: 399 PAGES: 3

More Info
									Payroll Deduction Approval
Form
This Payroll Deduction Approval Form can be used by a company to receive approval
from an employee to deduct certain amounts from each paycheck. A payroll deduction
plan offers employees a convenient way to automatically contribute income toward an
ongoing expense. Typically, the funds are put towards education expenses, uniform
usage fees, drawer shortages, and more. This form contains standard provisions and it
may be customized to address the specific needs of the employer or employee. This
document should be used by employers that offer a payroll deduction plan to
employees.
                                                               Payroll Deduction Authorization


               PAYROLL DEDUCTION AUTHORIZATION

Employee Name:

Address:

Telephone:                                 Employee ID Number:

Social Security Number:


Payroll Deductions Shall be Deducted as Follows (check one):


Weekly:        □
Bi-Weekly      □

Monthly        □
THE EMPLOYEE HEREBY AUTHORIZES THE COMPANY TO DEDUCT THE
FOLLOWING DEDUCTIONS FROM THE EMPLOYEES PAYCHECK:



       (i)     ___________________________ in the amount of $______________________
       (ii)    ___________________________ in the amount of $______________________
       (iii)   ___________________________ in the amount of $______________________


DATED this ____ day of __________________, 2______.



Witness:                                          Employee’s Signature
                                                                                             Payroll Deduction Authorization


								
To top