Employees may sometimes borrow money or otherwise become indebted to their employers for a variety of reasons. When this occurs, employers should require the employee to sign a promissory note to document the employee's obligation to repay the debt. This Form is a sample promissory note that authorizes the employer to deduct regular installments from the employee's paychecks.

This Form is in Microsoft Word® (".doc") format. To download it, click on the "View Form" link below or at the top of this page. The Form will open in a word processor, which allows you to customize it. To save the Form on your local drive, click on the "File" menu in your word processor and select "Save As...."

In this Form, bolded text in brackets is used to highlight portions that must be adapted to your situation. Instructions on how to customize the Form are in bold italics, and suggested language is in bold non-italics.

This Form is a guide and may not be appropriate for a particular situation without modification. Employers should consult an employment lawyer about using this Form.