Voluntary Payroll Deduction Form Flipbook PDF


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Piedmont Driving Club Voluntary Payroll Deduction Authorization Form Employee Name: Next Payroll Effective Date: Name/Type of Deduction Example: PDC Cares

Deduction Amount Per Pay Period Example: $2.00

I hereby authorize my employer to make the above deduction from my weekly pay, in accordance with the above terms. I understand and agree that I am responsible for satisfying the above amounts and that any amount which is due and owing at the time of my termination, whether voluntary or involuntary, will be deducted from my last paycheck or any other amounts that may be owed me. This authorizes my employer to retain the entire amount of my last paycheck in compliance with the law. I further understand that deductions will be made after all mandatory taxes are withheld as well as for any employer programs in which I have enrolled, for which I am eligible, or to which I have agreed.

Employee Name Employee Signature Date I

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