We are passionate about building a community of kindness together with families & businesses through state-of-the-art laundry centers!

Pay Advance Request

Fill out the form below to request a pay advance...

Name

First Name

Last Name

Street Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing Address (if different from Street address)

Phone

(###)

###

####

I request an advance payment on my wages of:

If this request is approved, I would like to receive this advance by:

Cash

Direct Deposit

Check

*PLEASE SELECT ONLY **ONE** OF THE TWO OPTIONS BELOW...

OPTION #1 : REPAY THE ADVANCE IN 1 PAYMENT ON:

YYYY

OPTION #2 : PAYMENT PLAN : Please deduct the following amount weekly:

Beginning on the payroll date of:

YYYY

Ending on the payroll date of:

YYYY

If the balance of the last payroll deduction is less than the amount listed previously, the last payroll deduction amount will be:

Authorizations

I authorize Wash This Way to make deductions from my paycheck to repay this advance as indicated above.

I also agree that if I terminate employment prior to the total repayment of this advance, I authorize Wash This Way to deduct any unpaid advance amount from any wages owed me at the time of termination of employment.