Permanent Payroll Change — Breedlove & Associates
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Permanent Payroll Change
Your E-Mail Address
(Required)
Subject
(Required)
Employer Name
(Required)
Breedlove Account Number:
(Required)
Last 4 Digits of Social Security #:
(Required)
Name of Employee Affected
(Required)
Amount of New Gross Wage per Pay Period
Per
week (paid every week or 52 times per year)
bi-weekly (paid every two weeks or 26 times per year)
semi-monthly (paid twice a month or 24 times per year)
monthly (paid once a month or 12 times per year)
Change to Take Effect in the Pay Period Ending:
(Required)
03-07-2008
03-14-2008
03-21-2008
03-28-2008
04-04-2008
04-11-2008
04-18-2008
04-25-2008
05-02-2008
05-09-2008
05-16-2008
05-23-2008
05-30-2008
06-06-2008
06-13-2008
06-20-2008
06-27-2008
07-04-2008
07-11-2008
07-18-2008
07-25-2008
03-15-2008
03-31-2008
04-15-2008
04-30-2008
05-15-2008
05-31-2008
06-15-2008
06-30-2008
07-15-2008
07-31-2008
If Pay Is Hourly
New Regularly Hourly Rate (up to 40 hours per week):
New Overtime Rate (over 40 hours per week):
Number of Hours per Week:
Other Notes or Instructions (Please include your phone number in case we need to contact you with questions)
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