Deduction Authorization Form

Payroll Deduction Authorization

Name *

First

Last

Date of Birth *

Provide your DOB to confirm your account for deduction.

Email *

Phone *

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Please confirm your address is entered correctly, any mistakes will result in added shipping fees to resend.

Signature Required *

I authorize a one time payment of $35 from my paycheck for the B&B Staffing Planner.

I authorize B&B Staffing Management, to deduct $35 from my paycheck to purchase the B&B Staffing Planner. I understand that the cost of the above items will be deducted from my paycheck in full, as a one time payment. Once payment is made from the paycheck, arrangements will be made to mail or pickup the Planner.

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Payroll Deduction Authorization

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