Data Change Form

Please check the box and fill out related information for the data change you need to make. You can leave all other fields blank (unless noted as required).

"*" indicates required fields

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Employee Name*

Payroll Changes

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Pay Frequency
Workers Comp Code

Other Changes

If this change will affect your state withholding status, please contact TEL Staffing & HR Payroll Department at 850.476.9008.
Telephone Number
Must provide legal documentation
Stop Direct Deposit
Financial Institution
Account Info
Please explain in detail.

By typing your name on any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing.
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