Payroll Advance Form
Payroll Advance Deduction Authorization Form
Employee’ Name: ____________________________________ Date: _____________
Amount of the advance: $_____________ Check # __________ Dated: ____________
To be paid back in _______ Payments of $___________ which will be consecutively
taken out of the next ________ payroll checks.
I __________________________________(Employee Prints Name) understand that I am hereby requesting a salary advance, which I promise to repay in full. Boink Systems Incorporated has my personal guarantee that I will repay the full amount of this loan in the terms that have been set forth in this loan agreement. I also agree and understand that in the unlikely event of my termination of employment prior to the full repayment of this advance, Boink Systems Incorporated has my authorization to keep ANY monies due to me until the full amount of this load has been completely repaid.
Employee’s Signature:__________________________ Date: _____________
Authorized By: _______________________ Position: ____________________
REPAYMENT DETAILS:
Payroll Date Amount Paid Back Remaining Balance
___/___/___ $______________ $______________
___/___/___ $______________ $______________
___/___/___ $______________ $______________
___/___/___ $______________ $______________
___/___/___ $______________ $______________
___/___/___ $______________ $______________
___/___/___ $______________ $______________
___/___/___ $______________ $______________
___/___/___ $______________ $______________
___/___/___ $______________ $______________
___/___/___ $______________ $______________
___/___/___ $______________ $______________
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