AMOUNT * TO BE DEDUCTED MONTHLY: $

*(MINIMUM MONTHLY DEDUCTION IS $10)

I HEREBY AUTHORIZE THE ABOVE PAYROLL DEDUCTION FROM MY PAY EACH MONTH UNTIL FURTHER NOTICE FROM ME AND FOR TRANSMITTAL OF SAME AMOUNT TO THE ACTION CARD OFFICE FOR DEPOSIT TO MY BAMA CASH DEBIT ACCOUNT ON MY ACTION CARD. EMPLOYEES PAID BIWEEKLY WILL HAVE THE FULL MONTHLY DEDUCTION ON THE FIRST PAYROLL OF THE MONTH. EMPLOYEES PAID MONTHLY WILL HAVE THE DEDUCTION ON EACH END OF THE MONTHLY PAYROLL.

 

SIGNATURE:

DATE:

* * * * * * * * * * * * * * 

OFFICE USE ONLY:
ACCEPTED BY:	EFFECTIVE PAYROLL:
DATE:

COMMENTS: