Cleaning Services Wage Garnishment Form

Please carefully review the information provided in this form, ensuring accuracy and completeness. Should you have any questions or require further clarification regarding the wage garnishment process, do not hesitate to reach out to the appropriate department within our organization.

Employee Information:

Full Name:
Employee ID Number:
Address:
City:
State:
Zip Code:
Phone Number:
Email Address:

Employer Information:

Company Name:
Company Address:
City:
State:
Zip Code:
Phone Number:
Email Address:

Wage Garnishment Details:

Court Name:
Case Number:
Date of Judgment:
Amount Subject to Garnishment:
Percentage of Disposable Earnings to be Garnished:	$
Effective Date of Garnishment:	%
Frequency of Garnishment	weekly bi-weekly monthly

Payment Information:

Payroll Department Contact Name:
Payroll Department Contact Phone Number:
Payroll Department Contact Email Address:

Authorization:

I, [Employee's Full Name], authorize [Employer's Company Name] to deduct the specified amount from my wages as outlined in this wage garnishment form. I understand that this deduction is required by law and agree to the terms set forth by the court judgment.

Employee's Signature: