Payroll Deduction Authorization Agreement for Providence Farm - BATA
Please complete by May 31, 2019
Email address *
I authorize deduction from my net pay for Providence Farm CSA Share
Check which share type you are choosing: *
Deductions begin with pay date: June 2019
Amount to be deducted per pay period *
I authorize the above deduction per check until the total loan amount is paid. If my employment is terminated before the total is paid, I understand the balance is due upon termination and will be deducted in total from my final PTO payout. If any balance is due after that deduction, I agree to pay BATA within 15 days from the date of my termination.
Print Name: *
Your answer
Employee # *
Your answer
Work E-mail *
Your answer
personal E-mail *
Your answer
Address *
Your answer
Phone Number *
Your answer
Typed Signature *
Your answer
Date *
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