Payroll deduction authorization
Payroll deduction authorization form
I authorize ___________________________________ to make a deduction from my net
pay.
The deduction I authorize is for (Please put and "X" on the line):
______ (A) All of my net pay for each pay date.
______ (B) $________ of my net pay for each pay date.
_____________________________ Please print name legibly
Signature Date
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