Payroll Deduction Authorization Form - ECO -TEK
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Payroll Deduction Authorization Form
(For company assets)
Policy Manual # _______ __________
Beeper __________
Keys __________
Uniforms __________
Vehicle ________________ __________
Equipment __________
Tools __________
Credit Card # ___________________________ __________
Petty Cash __________
Other __________
Other __________
I acknowledge receipt of the above company assets loaned to me on this date. Should I leave the company, voluntarily or non voluntarily, and not return any one or more of the above items loaned to me by the company, I hereby authorize the company to deduct from my last payroll check(s) any of the above amounts that correspond with missing items. In addition, if the amounts owing by me to the company exceed the amount of my last payroll check, I acknowledge that I am legally liable for the balance still owing and that my employer may take legal action against me. If legal action should occur, I also accept responsibility for any and all legal fees derived from such action.
_________________________________ ____________________
Employee’s Signature Date
................
................
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