Type of Payroll Challenge *

Discount

Refund

Comp'd Service - PAY COMMISSION

General Error (wrong staff on service or tip etc)

YOUR NAME: *

Who is completing this form?

First Name

Last Name

Today's Date *

MM

DD

YYYY

Date of Service / Error

if applicable

MM

DD

YYYY

Guest Name *

First Name

Last Name

Service Provider

if applicable

First Name

Last Name

Discounted Services (check all that apply)

if applicable

Hair Cut

Blow Out / Style

Color

Highlights

Treatment

Waxing

Facial

TIP

Other