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Missing Payment Form
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* Indicates required question
Name
*
Your answer
Email
Your answer
Phone Number
*
Your answer
Date of Missing Payment
*
MM
/
DD
/
YYYY
Type of Pay
*
Choose
Hourly
Event
Other
What was the pay for (e.g. Smith Wedding, Avera Christmas Party, hourly wage for shop work, etc.)?
*
Your answer
Please List Any Other Details Pertinent to the Situation:
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