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Employee!Loan!/!Payroll!Advance!
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I,!______________________!have!requested!from!my!employer!
either!an!employee!loan!or!payroll!advance!in!the!
amount!of!$___________________.!
!
My!employer!has!agreed!to!lend/advance!me!funds!
based!upon!my!repaying!the!funds!via!my!payroll!on!
_______!on!or!at!$___________!per!pay!period!via!payroll!
deduction.!!!
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I!understand!and!agree!that!should!I!terminate!
employment!for!any!reason,!prior!to!the!complete!
repayment,!the!remaining!balance!due!will!be!deducted!
from!my!final!check.!!_____________!(Employee!Initial)!
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If!the!final!paycheck!is!insufficient!to!cover!the!complete!
reFpayment!of!this!loan,!then!I!promise!to!continue!
make!biFmonthly!payments!until!the!matter!is!paid!in!
full.!!My!employer!has!the!right!to!collect!these!funds!at!
my!expenses!(including!attorneys!fee’s)!should!I!fail!to!
perform.!
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______________________________! ! __________________________!
Employer! ! !!!Date! ! Employee! !!!!!!!Date!