"Employee Direct Deposit Enrollment Form"

ADVERTISEMENT
ADVERTISEMENT

Download "Employee Direct Deposit Enrollment Form"

411 times
Rate (4.5 / 5) 25 votes
Employee Direct Deposit Enrollment Form
.
Important! Please read and sign before completing and submitting
I hereby authorize Employer, either directly or through its payroll service provider, to deposit any amounts
owed me, 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
Employer, either directly or through its payroll service provider, to my account. In the event that Employer
deposits founds erroneously into my account, I authorize Employer, either directly or though its payroll
service provider, 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 Employer and Bank have revived written
notice from me of its termination in such time and in such manner as to afford Employer and Bank
reasonable opportunity to act on it.
Employee Name: ______________________
Employee Signature: ___________________
Date: ___________________
Account Information
Make sure to indicate what kind of account, along with amount to be deposited, if
less then your total net paycheck.
1. Bank Name/city/state: __________________________________________________________________
Routing/Transit #: ______________________
Account number: __________________________
__ Check __Savings __Other
I wish to deposit:$____.__ or __ Entire net amount
2. Bank Name/city/state: __________________________________________________________________
Routing/Transit #: ________________________
Account number: __________________________
__ Check __ Savings __Other
I wish to deposit: $____.__ or __ Entire net amount
Please note: you must attach a voided check to this form. Also
your first pay check will be a test check or “pre-note” so you
will receive a manual check for that pay period only. After
that it will be direct deposit.
Employee Direct Deposit Enrollment Form
.
Important! Please read and sign before completing and submitting
I hereby authorize Employer, either directly or through its payroll service provider, to deposit any amounts
owed me, by initiating credit entries to my account at the financial institution (hereinafter “Bank”)
indicated on this form. Further, I authorize Bank to accept and to credit any credit entries indicated by
Employer, either directly or through its payroll service provider, to my account. In the event that Employer
deposits founds erroneously into my account, I authorize Employer, either directly or though its payroll
service provider, to debit my account for an amount not to exceed the original amount of the erroneous
credit.
This authorization is to remain in full force and effect until Employer and Bank have revived written
notice from me of its termination in such time and in such manner as to afford Employer and Bank
reasonable opportunity to act on it.
Employee Name: ______________________
Employee Signature: ___________________
Date: ___________________
Account Information
Make sure to indicate what kind of account, along with amount to be deposited, if
less then your total net paycheck.
1. Bank Name/city/state: __________________________________________________________________
Routing/Transit #: ______________________
Account number: __________________________
__ Check __Savings __Other
I wish to deposit:$____.__ or __ Entire net amount
2. Bank Name/city/state: __________________________________________________________________
Routing/Transit #: ________________________
Account number: __________________________
__ Check __ Savings __Other
I wish to deposit: $____.__ or __ Entire net amount
Please note: you must attach a voided check to this form. Also
your first pay check will be a test check or “pre-note” so you
will receive a manual check for that pay period only. After
that it will be direct deposit.