"Direct Deposit Enrollment Form - Payroll Plus" - Florida

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Download "Direct Deposit Enrollment Form - Payroll Plus" - Florida

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Direct Deposit Enrollment Form
To enroll in Direct Deposit, simply fill out this form and give it to your payroll manager with a voided check for each
checking account – NOT A DEPOSIT SLIP. If depositing to a savings account, ask your 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.
Below is a sample check detailing where the information necessary to complete this form can be found.
ACCOUNT INFORMATION
You may choose up to three accounts below. (Your last item must be for the remaining amount owed to you.)
1. Bank Name, City, State: __________________________________________________________________
Routing/Transit Number: ___ ___ ___ ___ ___ ___ ___ ___ ___
Account Number: _________________________________________
Type of account: Checking
Savings
I wish to deposit $___________ OR
Entire Net Amount
2. Bank Name, City, State: __________________________________________________________________
Routing/Transit Number: ___ ___ ___ ___ ___ ___ ___ ___ ___
Account Number: _________________________________________
Type of account: Checking
Savings
I wish to deposit $___________ OR
Entire Net Amount
3. Bank Name, City, State: __________________________________________________________________
Routing/Transit Number: ___ ___ ___ ___ ___ ___ ___ ___ ___
Account Number: _________________________________________
Type of account: Checking
Savings
I wish to deposit $___________ OR
Entire Net Amount
PLEASE READ AND SIGN BELOW BEFORE SUBMITTING:
I hereby authorize my employer (hereinafter “Company”) to deposit any amounts owed by my initiating credit entries to my accounts
at the financial institutions (hereinafter “Bank”) indicated on both sides of this form. Further, I authorize Bank to accept and to credit
any credit entries indicated by Company to my accounts. In the event that Company deposits funds erroneously into my account, I
authorize Company 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 Company and Bank have received written notice from me of its
termination in such time and in such manner as to afford Company and Bank reasonable opportunity to act on it.
Name: ___________________________________
Social Security Number: ___________________________
Signature: ____________________________________________
Date: ____________________
Direct Deposit Enrollment Form
To enroll in Direct Deposit, simply fill out this form and give it to your payroll manager with a voided check for each
checking account – NOT A DEPOSIT SLIP. If depositing to a savings account, ask your 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.
Below is a sample check detailing where the information necessary to complete this form can be found.
ACCOUNT INFORMATION
You may choose up to three accounts below. (Your last item must be for the remaining amount owed to you.)
1. Bank Name, City, State: __________________________________________________________________
Routing/Transit Number: ___ ___ ___ ___ ___ ___ ___ ___ ___
Account Number: _________________________________________
Type of account: Checking
Savings
I wish to deposit $___________ OR
Entire Net Amount
2. Bank Name, City, State: __________________________________________________________________
Routing/Transit Number: ___ ___ ___ ___ ___ ___ ___ ___ ___
Account Number: _________________________________________
Type of account: Checking
Savings
I wish to deposit $___________ OR
Entire Net Amount
3. Bank Name, City, State: __________________________________________________________________
Routing/Transit Number: ___ ___ ___ ___ ___ ___ ___ ___ ___
Account Number: _________________________________________
Type of account: Checking
Savings
I wish to deposit $___________ OR
Entire Net Amount
PLEASE READ AND SIGN BELOW BEFORE SUBMITTING:
I hereby authorize my employer (hereinafter “Company”) to deposit any amounts owed by my initiating credit entries to my accounts
at the financial institutions (hereinafter “Bank”) indicated on both sides of this form. Further, I authorize Bank to accept and to credit
any credit entries indicated by Company to my accounts. In the event that Company deposits funds erroneously into my account, I
authorize Company 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 Company and Bank have received written notice from me of its
termination in such time and in such manner as to afford Company and Bank reasonable opportunity to act on it.
Name: ___________________________________
Social Security Number: ___________________________
Signature: ____________________________________________
Date: ____________________