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Check Pick-up Authorization

I give ACS permission to allow the person(s) listed below to pick up my paycheck. (This person must have a state issued ID with them to pick up my paycheck).

It is my responsibility to notify ACS if the above person is no longer authorized to pick up my paycheck. Please sign below to acknowledge that you understand

Select an option

***All authorized payroll checks to be picked up are subject to approval***

Thanks for submitting!

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