Employee Payroll Deduction Authorization Form - Free Download
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Employee Payroll Deduction Authorization Form
EMPLOYEE PAYROLL DEDUCTION AUTHORIZATION FORM
Employee Name: ___________________SSN: _____________
Deduction Effective Date: ___________________
Payroll Deductions:
401(k) % or $______________
401(k) Loan $______________
Health $______________
Employee Loans $______________
Other _________________ $______________
I agree that my gross pay will be reduced by the amount of my deduction as checked and
indicated above. In the event of a deduction change during the year, my employer is authorized
to deduct the new amount from my pay.
In the event a new Employee Deduction Authorization Form is not executed on or before the
next year-end, this form shall be deemed to continue in force for the next succeeding year.
Employee Signature: _____________________ Date:___________
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