DIY Legal Forms

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Authorisation Of Payroll Deduction

Date

THE UNDERSIGNED DO HEREBY AUTHORISE [Name] of [Address], hereinafter referred to as "Company", to deduct the amount of [$------] from [Name] gross earnings each payroll period beginning [Date].

In payment for [Enumerate].

As per agreement, these deductions will continue until the above obligation is paid in full or until employment with said company is terminated for any reason. Should employment be terminated prior to the payment in full of this obligation, the undersigned agrees to pay the balance owed on or before the termination date.

Signature

Undersigned

Print Name:

Taxation Indentification No:

Please keep a copy of this for your records.