Payroll Allotment Authorization
Authorize payroll distribution to designated accounts. Complete all required fields for processing.
Employee Full Name
*
First Name
Last Name
Employee ID
*
Department
*
Contact Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Allotment Type
*
Percentage of Net Pay
Fixed Dollar Amount
Allotment Value (Enter percentage or amount as selected above)
*
Recipient Name (Bank or Institution)
*
Recipient Account Type
*
Checking
Savings
Other
Last 4 Digits of Recipient Account Number
*
Effective Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employee Signature
*
Submit Authorization
Submit Authorization
Should be Empty: