PAYROLL AUTHORIZATION

 GROUP LEADER’S NAME:         DATE:

PLACE OF ENGAGEMENT:       JOB #:

DATE OF ENGAGEMENT:      CONTRACT #:

Total Price:           Contract Price:

AFM/EPF:            Service Charge:

General Excise Tax:          Sub Total:

Other Fees:          Group Taxes:

Contract Price:           Total Payroll:                                 

The Leader is to be assessed an additional $10.00 per adjusted check for any error made by the Leader on the payroll line-up for information.

The Leader, by signing and mailing this form (or by emailing this form to payrollmsiesi@aol.com), assumes responsibility for the correctness of

the above information and authorizes payroll processing to begin.

 Authorization:       Date:

Instructions on emailing this form: 1..Fill out the form online. 2. Right Click on the form and select all.

3. Right Click again and copy. 4. Right Click where your message would normally go in your email and Paste.

Email  to: payrollmsiesi@aol.com