Employee Payday Advance Agreement

Employee Payday Advance Agreement
Employee Name*

First NameLast Name
Last Four of Social*
Client Name*

First NameLast Name
I, blanks* request an advance payment of $blank* of my wages/salary payable on my next payroll. I understand that I am eligible for no more than one emergency payroll advance per pay period and that amount not to exceed my earnings with fees. All advances are paid back in full in one check. There will be flat fee of $35.00 for all loans and a 25% fee of the amount you borrowed.

Please ensure the PayPal name correct. If you enter it in wrong, Gentle Hands Home Care LLC is not responsible for the funds being deposited in the wrong account. The loan will still be taken out of the next payroll check. We copy and paste the name to insure its correct. If you fill out a loan form, more than once due to error, you will pay a $10.00 fee.
If this request is approved, I would like to receive this advance by paypal (type email)*
Date*

MonthDayYear
Signature*

Clear
Please verify that you are human*
Should be Empty: