Payroll Advancement/Loan
    Request 

    To qualify for an Interest free Payroll advancement employee's must be employed at least 60 days. Must be in good standing with the company, not experiencing any disciplinary actions. Must provide proof of bills, please note not every pay advance is approved.  Our Executive Board may approved your advance assessment pay with the understanding that we will advance the sum of the amount to you and your paychecks will reflect the debits accordingly until the is paid in full to satisfy our fiduciary planning with LeBlanc Consulting Accounting Practices.
    Max file size: 20MB
    I am requesting an advance payment of the above amount on my wages/salary payable on the above payroll date . I understand that I am eligible for no more than two emergency payroll advances per calendar year and that the amount requested shall not exceed 60% of my earnings to date for the current month. I agree that the amount of money I am requesting must be paid back within six months. If this request is approved, I would like to receive this advance by direct deposit. By clicking submit and signing this form, I authorize Employer Flexible to make deductions from my paycheck to repay this advance through either: 1) one payroll deduction to be made from wages/salary payable the first pay period immediately following the pay period from which this advance is made or: 2) from equal deduction amounts agreed upon by LeBlanc Consulting Accounting and Payroll Department from the next pay periods immediately following the pay period from which this advance is made. I also agree that if I terminate employment prior to total repayment of this advance, I authorize the Employer Flexible to deduct any unpaid advance amount from any wages/salary owed me at the time of termination of employment. If I do not have a final check, I authorize LeBlanc Consulting to place my account in collections and reportable to the three credit monitoring agencies.