Demand Replacement Check

The Delaget Payroll team is ready to work on your case! This form is used to generate an out of payroll cycle check for an employee who needs a replacement check. Please fill in all fields on the form below. Also, please ensure that you put the title, name and email of the person filling out the form at the bottom. This is how we connect the case to your account and can provide you with updates as we work through the case. As always, please reach out to us if you have any concerns or questions. Thank you!


Employee ID:

Employee Name:


Restaurant #/District Manager:

Delivery Method:

Deliver To:

Replacement Reason:

Date of Check to be Replaced:

Amount of Check to Be Replaced:

Is Stop Payment Necessary:

Charge Employee Fee (if applicable):

Contact Role: