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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