BWDWG Paper Check Authorization Form

Please print and complete ALL the information below.

Name: ____________________________________________________________

Address: ____________________________________________________________

City, State, Zip: ____________________________________________________________

Business Unit: Corporate Surf Cat Marketing BWD Print Solutions Kahuna Health

Position Title: ____________________________________________________________

Department: ____________________________________________________________

BWD Web Group is hereby authorized to deduct $1.00 from each paycheck, for administrative
and postage fees. I choose to receive my payroll check through the U.S. Mail at the address
specified above. I understand that the company will not replace payroll checks lost or delayed
by the U.S. Post Office within five working days following payday. I must contact the BWDWG
Human Resources Office to change my permanent home address used for mailing purposes.
This authorization will remain in effect until I modify or cancel it in writing.

Employee Signature: ____________________________________________________________

Date: ___________________________