Paycheck Pick-Up Authorization Form

Finance Department - Employee Paycheck

This is to confirm that I, *, authorize the below-listed individual designee to pick up/receive my payroll paycheck on my behalf at the following time(s):

Payroll Date Allowed: *

Name of Designee: *

Pickup/Receiving Frequency:
* Please specify if one-time pickup or always (continuous) -

One Time

Continuous

Physical Pickup or Electronic (Direct Deposit):
* Pick one below -

Physical Pickup

Direct Deposit

If direct deposit is selected, enter your Zelle, Venmo, and/or Cashapp information below:
Zelle -
Cashapp -
Venmo -

***Picture ID Must be Presented by the person Picking up the paycheck.
***Electronically sent paychecks will be sent via Cashapp, Venmo, or Zelle.
***Please note you must submit, in writing to Human Resources, notice if this designation should be changed at any time. Human Resources will not be held accountable for checks picked up if the designation has not been updated.

Signed Date: October 29, 2026

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw Signature
Type In Signature

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Timestamp

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December 20, 2023 12:23 PM CDT

Paycheck Pick-Up Authorization Form Uploaded by Michael Vennova - hi@emmydrafts.com IP 47.186.115.194

December 21, 2023 1:15 AM CDT

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December 21, 2023 1:21 AM CDT

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December 22, 2023 8:17 PM CDT

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December 22, 2023 8:19 PM CDT

Emmy Drafts - vault+sign@emmydrafts.com added by Michael Vennova - hi@emmydrafts.com as a CC'd Recipient Ip: 47.186.115.194