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Effective Date __/__/____
Employer [Legal Name], AKA (The Employer)
Located at [Address]
[City], [State] [Zip Code]
&
The Employee [Legal Name], AKA (The Employee)
Located at [Address]
[City], [State] [Zip Code]
The Employee hereby acknowledges a debt to the Employer in the amount of $ _________.
For the following reason:
________________________________
The Employee acknowledges and agrees that an interest rate of ____% per year will accrue on any outstanding amount and that the repayment shall first be applied to the interest and then the principal amount.
The Employee hereby gives permission to the Employer to deduct $__________ bi-weekly from the Employee's pay check starting ____/____/______ until the full amount of the above stated loan is paid in full.
The Employee also agrees that any outstanding amount will be deducted from the Employee's final pay check upon resignation or termination of employment from the Employer.
________________________________
Signature
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