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Notice of Termination
Flex Checks, Inc.
2930 Three Mile Rd NW
PO Box 141215
Grand Rapids, MI 49514-1215
Toll Free: (866) 791-7900
T: (616) 791-7900
F: (616) 791-7901

Answer all questions that apply

  • If you are DISCHARGING an employee, complete Part 1 and 2 PRIOR TO DISCHARGE.
  • If an employee has QUIT, please complete Parts 1 and 2 AS SOON AS POSSIBLE.

Part 1.
Company Name: Date:
Employee Name: SS #:
Termination Date: Last Paycheck Date:
       
Part 2.
Employees YTD Flex Deductions (include amount for final paycheck):
Med FSA:    
Dependent Care:    
       
   
Supervisor/Employee Comments:
 
 



 
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