Payroll Deduction Authorization Form
Email *
Name of Employee *
Employee Identification Number *
Building you work in. This is used for T-Shirt delivery *
Amount Per Pay Period to be Deducted
($3 or more per pay period is required to get your t-shirt and jeans passes)
 *
Is this a change from last year? New to payroll deduction, new amount to deduct, etc *
Unisex T-Shirt Size (If you are giving $3 or more a pay period) As long as you give $3 or more per pay period you get a new T-Shirt each year.  *
I hereby authorize Clark-Pleasant Corporation to withhold from my wages the amount listed above for the purpose of my Clark-Pleasant Education Foundation donation. I authorize a payroll deduction out of my paycheck until I state otherwise. 
(Please type your name below as a signature)
 *
A copy of your responses will be emailed to .
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Clark-Pleasant Community Schools. Report Abuse
Google Forms