Employee Request For Salary Advance
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Name of Employee
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I am requesting an advance payment of my salary in the amount of $ ______.
Select Repayment Terms
[__] I agree that this salary advance will be repaid in full by making a deduction from the next scheduled paycheck
[__] I agree that this salary advance will be repaid by making equal deductions from the next ____ paychecks.
I authorize, if employment ends prior to full repayment is made, that the remaining balance due will be deducted from the final paycheck.
_______________________ Date_____
Employee Signature
_______________________ Date_____
Manager Signature
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