Payroll Deduction Authorization

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Payroll Deduction Authorization
Employee Name
Employee #
Address
City, State, Zip
Phone
Email Address
This deduction will go to:
(please check one)
I would like this deduction to occur:
(please check one)
every paycheck
every other paycheck
other (describe):
Amount to deduct:
By signing below, I authorize
to deduct
the above listed amount from my paycheck.
Employee Printed Name
Employee Signature
Date:

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Parent category: Business
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