Editing previous response:

Please fix the highlighted areas below before submitting.

Request for Paper Check

If you have any questions relating to this form or if you need the check mailed to you because you have moved and can no longer pick it up in person, please email [email protected]. Please note that this request can take one business day to process and therefore depending on the time of request a direct deposit could still be issued.

Name*

Answer required for "Name"

Payroll date for which a paper check is being requested*

Answer required for "Payroll date for which a paper check is being requested"

Mailing Address*

Answer required for "Mailing Address"

Phone Number*

Number Required

Due to extenuating circumstances, I am requesting to receive a paper check beginning on the next payroll, until I bring in new banking information to the district office. I understand that my check will not be mailed, and I will be responsible for picking up the check during regular business hours at the district office. I also understand that if I have not picked up my check within one year, the check will be voided and turned over to the Idaho State Treasurer as unclaimed property. *

Answer required for "Due to extenuating circumstances, I am requesting to receive a paper check beginning on the next payroll, until I bring in new banking information to the district office. I understand that my check will not be mailed, and I will be responsible for picking up the check during regular business hours at the district office. I also understand that if I have not picked up my check within one year, the check will be voided and turned over to the Idaho State Treasurer as unclaimed property. "

I understand

If you would like to give someone else permission to pick up the check on your behalf, please enter their name below.

Answer required for "If you would like to give someone else permission to pick up the check on your behalf, please enter their name below."