Payroll On-Line Check Form
200 Piedmont Avenue, Suite 1604 West Tower, Atlanta, GA 30334 Phone (404) 463-1993, Fax (404) 463-5089
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Requestors Name:
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Requesting Agency Name:
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Date Requested:
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Phone Number:
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Email Address:
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Agency PeopleSoft Business Unit:
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Employee Name:
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Employee ID #:
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Employee Record #:
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Pay Group:
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Page#/Line#:
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Total Gross:
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Total Taxes:
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Total Deductions:
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Pay End Date:
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Net Pay:
Earnings
Code
Amount
Tax
Code
Amount
Deductions
Code
Amount
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The check should be printed at the following location:
SAO
Remote Location
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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
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Indicates Response Required