Personal Loan Application Form - Nh Hicks Page 2
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1
2AUTHORIZATION FOR PAYROLL DEDUCTIONS
To be completed and provided to payroll department upon completion of amortization schedule
PLAN NAME:
Participant:
Social Security #:
I hereby authorize payroll deductions in the amount of $
with a final payment of
$
for a period of
years.
Date
Participant’s Signature
Date
Witness’s Signature
Note: All payroll deductions for loan repayment must be made on an after-tax basis.
HICKS
NH
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