Payroll Deduction Authorization Form Free Template

Payroll deductions can be a complicated business. The calculations can include things like salary, hourly wages, bonuses, and other deductions. Making your employee forms the best they can be is a great way to avoid deduction errors down the road. We like to offer the following as a payroll deduction authorization form free template.

Here are a few tips for the form you use to figure payroll deductions for your employees. You should customize the following according to what is relevant for your particular business.

The authorization form usually has the normal areas to identify the employee:

  • Company Name
  • Name of the Employee’s Department
  • Department Identification Number
  • Employee Name
  • Employee Title
  • Employee Number


Have a place on the deduction authorization form to identify the way the form is going to be used:

  • Check One:
    • Initial payroll deduction
    • Terminate payroll deduction
    • Change payroll deduction


A list of the deductions being requested, most of which should include options to deduct as fixed dollar amount, or a percentage of net pay:

  • 401(k) Plan
  • Other Employee Savings Plan
  • Union Dues
  • Loan Repayment
  • Parking Fees
  • Health Savings Plan


A place for the employee to sign, authorizing the use of the information to make payroll deductions. Something like:


“I (add employee name) authorize (add company name) to make the above deductions from my gross earnings every month, beginning (start month and year).”


I understand and acknowledge the deduction may not be made if I have insufficient income during a pay period.

I understand and acknowledge dues such as Income Tax and Social Security Tax take priority over these deductions.

I understand deductions may not take effect during the current payroll cycle.

I will not hold (company name) liable for any deductions that are not made.

Employee Signature: _____________________________________

Employee Name (printed): _________________________________

Date: __________________________________________________


At the bottom of the form, list some internal tracking fields to help your human resources staff process the forms. Something like:


Received (date)

Received by (name)



As a business owner, managing payroll is not easy. Try to have a tracking system in place to make sure all new employees fill out this form, and keep it on file. In addition, make it clear to current employees changing their deductions on when the changes will take effect.

As a local business service company in Columbia, MO, Moresource strives to provide informative resources relevant to business owners and c-level executives. We provide help with risk management, human resource outsourcing, and payroll management, along with our other core services.