Pet Service Payroll Deduction Authorization Form

Please review the steps below to ensure the payroll deduction for your pet service.

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Your Manager

Name

First

Last

Location

Department

Pet Name

Invoice #

Total Invoice Balance

Amount to be deducted bi-weekly

Deduction start date

Total # of payroll deductions

Checkboxes

I authorize Partner Veterinary to deduct the below amount on a bi-weekly basis for the pet services received until invoice is paid in full.

Checkboxes (copy)

If employment ends before completion of payments, the remaining balance will be deducted from my final paycheck.

Signature (copy)

*By typing your name above you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

Date / Time (copy)