Date: _______________

Advance Amount $ _______________

Employee Name: __________________________________________

Agreement:

I, the undersigned employee, in consideration of the above advance pay given to me by Timberville Electronics, hereby authorize Timberville Electronics Payroll Department to deduct the above advance amount in equal installments from the net earnings payable to me for the ( 3 ) pay periods immediately following the date of receipt of the advance amount. I understand that each such deduction shall be ($_____). I fully understand and agree that the total of all payroll deductions for repayment of this advance shall be equal to the total amount advanced in accordance with the above schedule.

I further understand and agree that my acceptance of the advance amount and this related authorization for payroll deduction shall in no way be construed as a contract for my continued employment with Timberville Electronics. In the event of my termination of employment with Timberville Electronics, whether voluntary or involuntary, prior to the total recovery by Timberville Electronics of the amount advanced to me, I authorize Timberville Electronics to deduct the full remaining balance of this advance from my final paycheck. In the event my final paycheck is insufficient to repay the advance, I recognize my absolute and irrevocable obligation to fully repay any remaining balance to Timberville Electronics; after my final paycheck has been credited against the advance amount owed.

Signatures:

(Employee)  ___________________________ ______________

                     Date ___________________

Approved:

(Supervisor) ___________________________ ______________

                        Date ____________

(Payroll Dept.) ___________________________ ______________ ______________

                         Date ______________