Employee Direct Deposit Enrollment Form printable pdf download

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