Impact PT Staff Pay Request Form

Full Name(*)
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E-mail(*)
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Phone Number
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Type of Session(*)
Please tell us how big is your company.

Full Address(*)
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Session Info and Details of Pay Request(*)
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Please detail the dates you worked sessions and the start / end time. Please detail should there have been any change to session times dues to weather. Should a wage amount have been agreed prior please detail here and also please provide a TOTAL for the amount you are requesting. Thank you.

Please enter your name as your E Signature(*)
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I have provided full and accurate information as above. I understand my rights and responsibilities as a Self Employed Contractor.

Please verify(*)
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