Payroll Advance Form - boink（工资形式boink）.DOC

Payroll Advance Deduction Authorization Form Employee’ Name: ____________________________________ Date: _____________ Amount of the advance: $_____________ Check # __________ Dated: ____________ To be paid back in _______ Payments of $___________ which will be consecutively taken out of the next ________ payroll checks. I __________________________________(Employee Prints Name) understand that I am hereby requesting a salary advance, which I promise to repay in full. Boink Systems Incorporated has my personal guarantee that I will repay the full amount of this loan in the terms that have been set forth in this loan agreement. I also agree and understand that in the unlikely event of my termination of employment prior to the full repayment of this advance, Boink Systems Incorporated has my authorization to keep ANY monies due to me until the full amount of this load has been completely repaid. Employee’s Signature:__________________________ Date: _____________ Authorized By: _______________________ Position: ____________________ REPAYMENT DETAILS: Payroll Date Amount Paid Back Remaining Balance ___/___/___ $______________ $______________ ___/___/___ $______________ $______________ ___/___/___ $______________ $______________ ___/___/___ $______________ $______________ ___/___/___ $______________ $______________ ___/___/___ $______________ $______________ ___/___/___ $______________ $______________ ___/___/___ $______________ $______________ ___/___/___ $______________ $______________ ___/___/___ $______________ $______________ ___/___/___ $______________ $______________ ___/___/___ $______________ $______________ 3333 nw 21st street ? miami ? fl ? 33142 ? Phone: (800)go-boink ? Fax: (305)468-6244