ORDER TO EMPLOYER TO PAY CHAPTER 13 TRUSTEE ORDERED: 1. [Name of Employer and mailing address] is ordered to pay $________ each pay period out of the income of [name of debtor] to the chapter 13 trustee. Payment shall be made to: [Trustee's name and address] 2. These wage deductions shall continue until further order of this Court. 3. The chapter 13 trustee and the debtors shall each submit a copy of this order to the employer. ReservedForJudgeSignature American LegalNet, Inc. www.FormsWorkFlow.com