I acknowledge on [date] I received an over payment in the amount of $____________. I understand that [Company Name] will need to be reimbursed. I have selected the checked option below to repay the company.
____ Deduct the overpayment from my salary from next pay period.
____ Deduct the overpayment from my salary from the next [number] paychecks in the amount of $____.
____ I will repay the overpayment with a personal check.
In addition, I authorize the deduction of my final paycheck for the amount still due at termination.
________________________________________
Employee name
_______________________________________ ___________________
Employee signature Date
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