Arizona PayRoll Correction Form

Paycheck Correction and Repayment Form

Employee Name(Required)

Phone Number(Required)

Email(Required)

Mailing Address(Required)

Check #

We have this, if you are not aware.

Check Amount

We have this, if you are not aware.

Preferred Repayment Option(Required)

Mail Check

In Person Check Pickup - Date and Time TBA

Digital Payment Platform (Venmo, Paypal, CashApp)

Digital Payment Handle Address/ Profile

Please include your CashApp, Venmo, PayPal, etcc handle

Repayment Notes

If opting for Digital Payment provide which digital payment app you would like to use

Additional NSF Fees

Did you incur any additional bank fees as a result? If so how much.

File

Max. file size: 100 MB.

Please upload a picture of NSF and any other associated charges.