Authorization Agreement For Direct Deposit Of Payroll

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Goodwill Industries of
Greater New York & Northern New Jersey, Inc.
Authorization Agreement for Direct Deposit of Payroll
I hereby authorize Goodwill Industries of Greater New York and Northern New Jersey, Inc.
To deposit my net pay as follows:
Check one option:
Full net amount to Checking
Full net amount to Savings
Partial Flat $$ amount to Savings
$ ___________
Remainder of Net into Checking
$ 100%
Partial Flat $$ amount to Checking
$ ___________
Remainder of Net into Savings
$ 100%
To ensure that each account is properly credited, I have attached a “Voided check” and or letter from my
bank for each account where my pay will be deposited. I have completed and signed the form below. I
agree that this authorization will remain in effect until I provide written notification to Goodwill Industries
of Greater New York and Northern New Jersey, Inc. terminating this service.
Electronic Transfer of Funds
Primary account details
Checking ____ Savings ____ (Check one)
Name of Bank
Bank Address
ABA or Routing #
Account #
Secondary account details (If applicable)
Checking ____ Savings ____ (Check one)
Name of Bank
Bank Address
ABA or Routing #
Account #
(*) An example is provided on the page to help you fill out your bank number and account number. To allow the Payroll Department
to verify this information, please attach a voided check or savings deposit slip (for each account you specify) to the following page.
We will NOT accept this application without documentation from your bank(s)
Today’s Date
Print Employee Name
Signature
1

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