Download payroll deduction form

PAYROLL DEDUCTION FORM
Employee Name: _________________________________________________________
Store:
_________________________________________________________
Date:
_________________________________________________________
Item Ordered:
Price:
___________________________
__________________
___________________________
__________________
___________________________
__________________
___________________________
__________________
TOTAL:
__________________
I understand that the cost of the above items will be deducted from my next paycheck. I
also understand that I will be responsible for shipping. I further understand that it is my
responsibility to pay for any costs associated with returning items.
I authorize King Neptune Fish and Poultry Market, Inc to deduct the balance owed for
my purchase following the receipt of an invoice from CREST UNIFORM or appropriate
apparel vendor.
If I terminate my position prior to the purchase being paid in full, I authorize King
Neptune Fish and Poultry Market, Inc. to deduct the unpaid balance from my final
paycheck.
THIS IS A VOLUNTARY PROGRAM AND IS NOT A CONDITION OF
EMPLOYMENT WITH KING NEPTUNE FISH AND POULTRY MARKET, INC.
__________________________________________________
Employee Signature
__________________
Date