Employee Information Sheet - Checkright (Page 4 of 4) in pdf

Employee Information Sheet - Checkright Page 4

Authorization for Direct Deposit

I authorize my employer to instruct the payroll provider, Checkright, to deposit my

pay automatically to the account indicated below so that my pay will be via “Direct

Deposit.” This authorization extends to Checkright’s banking and/or payroll software

partners.

I specifically give permission to my employer and Checkright to make adjusting or

reversing entries on my account in the event of a mistake or error. I understand that

power outages, internet outages, banking errors, human errors, terrorist acts, and acts of

God all could prevent my pay from being deposited according to the normal pay

schedule. I agree to hold harmless my employer, the banks, and Checkright if any

problem were to occur.

I understand that this authorization will remain in effect until I cancel it in writing and

such time beyond that cancellation that affords Checkright a reasonable opportunity to

act on the cancellation.

Company Name:

Employee Name (Please Print):

Employee Signature:

Date:

Bank Name:

Checking

OR Savings

Routing Number:

Account Number:

Please attach a voided check and fax to Checkright at 804-716-2387 or

email to payroll@checkright.net. Please fill out two forms if you are

splitting your deposit into two accounts.

EMPLOYER: Employer must retain direct deposit authorizations for two years past

revocation of direct deposit or termination of employee. If employer relays account

information directly to Checkright without Authorization for Direct Deposit, employer

warrants that employer has signed Authorization for Direct Deposit on file.

Employee Information Sheet - Checkright Page 4