Payroll On-Line Check Form
200 Piedmont Avenue, Suite 1604 West Tower, Atlanta, GA 30334 Phone (404) 463-1993, Fax (404) 463-5089
Requestors Name:
Requesting Agency Name:
Date Requested:
Phone Number:
Email Address:
Agency PeopleSoft Business Unit:
Employee Name:
Employee ID #:
Employee Record #:
Pay Group:
Page#/Line#:
Total Gross:
Total Taxes:
Total Deductions:
Pay End Date:
Net Pay:
Earnings
Code
Amount
Tax
Code
Amount
Deductions
Code
Amount
The check should be printed at the following location:
SAO
Remote Location
Please select from the following check delivery options:
Pickup
FedEx
Airborne
Courier
Other
If you selected other above please give detailed information.
State Accounting Office Use Only
Processed By SAO:
Date:
Check Number:
SAO Form: 100-D
Indicates Response Required