Deduction Form

Please fill-out the form below in its entirety. Thank you!

Employees Name

First Name

Last Name

1- Items Provided

2- Items Provided

3- Items Provided

4- Items Provided

Deduction Total

Deduction Taken From

Current Paycheck

Next Paycheck

Acknowledgement Of Understanding

The employee has been informed of the deductions that will be made and is aware the deduction total listed above will be deducted from my paycheck in increments as listed above on a weekly bases, until paid back in full.

Yes, I agree and understand