Form

REQUEST FOR A PAYROLL DRAW

Use to request a payroll draw, can only be done once per month, requests are due by the 10th of the month. Requests can be one time or set up as recurring.
For the Month Of *
Year *
Submission Date *

- Month - Day Year
A. EMPLOYEE INFORMATION:
Full Name

First Name Last Name
Cell Phone Number *

- Area Code Phone Number

Address *

B. DRAW INFORMATION
- Advances are processed and ready for pick-up, on the 15th of each month. Pick up schedule may vary due to weekends and holidays.
- To stop a recurring draw request please send an email to shahn@oregoncoastcc.org
Payment Disposition

Mail to the address above. I will pick up.
Please check one: *

Hourly Employee Salaried Employee
Hourly Employees Upload copy of your time-card.
Frequency *

One-Time Ongoing, each month
Draw Amount *

Max Amount Requested
Amount Requested
PLEASE READ CAREFULLY

*** Pay advances will be no more than 70% of your gross earnings at the time of the request.
*

I Agree
By typing my name I agree to authorized Oregon Coast Community College to deduct from my next regular paycheck the amount of the draw requested above.
Please Run the Wizard
Should be Empty:

REQUEST FOR A PAYROLL DRAW