PAYROLL DEDUCTION AUTHORIZATION
PAYROLL DEDUCTION AUTHORIZATION
Client Company Name: ________________________________________________
I _______________________________________ authorize Merit Resources to deduct
(print name of employee)
payments of $____________ per pay period up to a maximum of $______________.
I acknowledge that this deduction is for ____________________________.
Should I leave the employement of the Client Company before the debt is paid in full I authorize Merit Resources, Inc. to deduct the remaining balance from my final pay check. If there is still an outstanding balance I authorize that I will make full payment to the Client Company within 21 days of the final day of employment.
________________________________________ ______________________
(signature of employee) (date)
________________________________________ ______________________
(signature of authorized supervisor) (date)
________________________________________
(print supervisor name)
Merit Resources, Inc.
Rev: 2015
................
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