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Back to Forms for 'Compensation & Benefits'.


PAYROLL DEDUCTION AUTHORIZATION - TYPE A

PAYROLL DEDUCTION AUTHORIZATION - TYPE A

 

 

I authorize __________________

 

To deduct $ _________________ from my gross earnings each payroll period beginning _____________________.

 

IN PAYMENT FOR:                             AMOUNT

 

[  ] Credit Union                                _________.___

 

[  ] Employee Savings Plan             _________.___

 

[  ] 401 K Plan                                    _________.___

 

[  ] Union Dues                                 _________.___

 

[  ] _________________                               _________.___

 

Total                                               $_________.___

 

 

Signature __________________________                           Date ________________

 

Print Name ________________________

 

Social Security # ______-______-______

 

Please keep a copy of this for your records.



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