"Employee Direct Deposit Enrollment Form"

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Employee Direct Deposit Enrollment Form
Payroll Manager—Please complete this section and fax form to PAYROLLplus with bi-weekly payroll worksheet for
employee enrollment. Contact Donna with PAYROLLplus for further instructions on how to update your employee’s direct
deposit information. (Please print.)
Company Name: _______________________________________________ Employee Number: ___________________
Payroll Manager Name: __________________________ Payroll Mgr Signature: ________________________________
To enroll in Direct Deposit, simply fill out this form and give it to your payroll manager. Attach a voided check for each
checking account—not a deposit slip. If depositing to a savings account, ask the bank to give you the Routing/Transit
number for your account. It isn’t always the same as the number on a savings deposit slip. This will help ensure that you
are paid correctly.
Important! Please read and sign before completing and submitting.
I hereby authorize PAYROLLplus to deposit any amounts owed me, as instructed by my employer, by initiating credit
entries to my account at the financial institution (hereinafter “Bank”) indicated on this form. Further, I authorize Bank to
accept and to credit any credit entries indicated by PAYROLLplus to my account. In the event that PAYROLLplus
deposits funds erroneously into my account, I authorize PAYROLLplus to debit my account for an amount not to exceed
the original amount of the erroneous credit. This authorization is to remain in full force and effect until PAYROLLplus and
Bank have received written notice from me of its termination in such time and in such manner as to afford PAYROLLplus
and Bank reasonable opportunity to act on it.
Employee Name: _____________________________ Social Security #______-____-________
Employee Signature: _____________________________ Date: _________________________
Account Information
Make sure to indicate what kind of account is being used for your direct deposit.
Type of Account: Checking____ Savings____ Other____________________________
Bank Name/City/State: ______________________________________________________________________________
Routing/Transit #: __________________________________ Account #: __________________________________
ATTENTION PAYROLL MANAGER:
Employers must keep each original employee enrollment form on file as long as the employee is using Direct
Deposit, and for two years thereafter.
Employee Direct Deposit Enrollment Form
Payroll Manager—Please complete this section and fax form to PAYROLLplus with bi-weekly payroll worksheet for
employee enrollment. Contact Donna with PAYROLLplus for further instructions on how to update your employee’s direct
deposit information. (Please print.)
Company Name: _______________________________________________ Employee Number: ___________________
Payroll Manager Name: __________________________ Payroll Mgr Signature: ________________________________
To enroll in Direct Deposit, simply fill out this form and give it to your payroll manager. Attach a voided check for each
checking account—not a deposit slip. If depositing to a savings account, ask the bank to give you the Routing/Transit
number for your account. It isn’t always the same as the number on a savings deposit slip. This will help ensure that you
are paid correctly.
Important! Please read and sign before completing and submitting.
I hereby authorize PAYROLLplus to deposit any amounts owed me, as instructed by my employer, by initiating credit
entries to my account at the financial institution (hereinafter “Bank”) indicated on this form. Further, I authorize Bank to
accept and to credit any credit entries indicated by PAYROLLplus to my account. In the event that PAYROLLplus
deposits funds erroneously into my account, I authorize PAYROLLplus to debit my account for an amount not to exceed
the original amount of the erroneous credit. This authorization is to remain in full force and effect until PAYROLLplus and
Bank have received written notice from me of its termination in such time and in such manner as to afford PAYROLLplus
and Bank reasonable opportunity to act on it.
Employee Name: _____________________________ Social Security #______-____-________
Employee Signature: _____________________________ Date: _________________________
Account Information
Make sure to indicate what kind of account is being used for your direct deposit.
Type of Account: Checking____ Savings____ Other____________________________
Bank Name/City/State: ______________________________________________________________________________
Routing/Transit #: __________________________________ Account #: __________________________________
ATTENTION PAYROLL MANAGER:
Employers must keep each original employee enrollment form on file as long as the employee is using Direct
Deposit, and for two years thereafter.