Employee Direct Deposit Enrollment Form printable pdf download

Employee Direct Deposit Enrollment Form

Payroll Manager—Please complete this section and fax form to PAYROLLplus with bi-weekly payroll worksheet for

employee enrollment. Contact Donna with PAYROLLplus for further instructions on how to update your employee’s direct

deposit information. (Please print.)

Company Name: _______________________________________________ Employee Number: ___________________

Payroll Manager Name: __________________________ Payroll Mgr Signature: ________________________________

To enroll in Direct Deposit, simply fill out this form and give it to your payroll manager. Attach a voided check for each

checking account—not a deposit slip. If depositing to a savings account, ask the 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.

Important! Please read and sign before completing and submitting.

I hereby authorize PAYROLLplus to deposit any amounts owed me, as instructed by my employer, 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 PAYROLLplus to my account. In the event that PAYROLLplus

deposits funds erroneously into my account, I authorize PAYROLLplus 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 PAYROLLplus and

Bank have received written notice from me of its termination in such time and in such manner as to afford PAYROLLplus

and Bank reasonable opportunity to act on it.

Employee Name: _____________________________ Social Security #______-____-________

Employee Signature: _____________________________ Date: _________________________

Account Information

Make sure to indicate what kind of account is being used for your direct deposit.

Type of Account: Checking____ Savings____ Other____________________________

Bank Name/City/State: ______________________________________________________________________________

Routing/Transit #: __________________________________ Account #: __________________________________

ATTENTION PAYROLL MANAGER:

Employers must keep each original employee enrollment form on file as long as the employee is using Direct

Deposit, and for two years thereafter.

Employee Direct Deposit Enrollment Form