Payroll Deduction Form Steel Toe Boots Price: # of ItemsRubber Steel Toe Boots Price: # of ItemsLeather Gloves Price: # of ItemsGloves Price: # of ItemsHard Hat Price: # of ItemsSafety Glasses Price: # of ItemsSafety Vest Price: # of ItemsSafety Goggles/clips, etc. Price: # of ItemsDOTMedcard Price: # of ItemsMotor Vehicle Report Price: # of ItemsNon DOT Physical Price: # of ItemsTotal Deduction Amount By signing below, I authorize the total deduction amount to be deducted from my next paycheck.Employee Name (Printed):(Required)Employee Email(Required) Employee Signature(Required)Date(Required) MM slash DD slash YYYY
