Employee Direct Deposit Enrollment Form

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Employee Direct Deposit Enrollment Form 
To enroll in direct deposit, fill out this form and return it to our offices. Attach a voided check for each account into which you would like to have 
money deposited.  Do not attach Deposit Slips.  If this is going into a savings account you will need to get the Routing/Transit number from your 
banking institution.  This is necessary to insure that your money is correctly deposited. 
Below is a sample of the MICR printing on a check.  This provides the information necessary to make deposits to your account. 
 
Account Information 
Please fill in the following information to tell us how you want your deposits distributed. Please be sure to indicate the Type of Account and the 
correct amount to be deposited from your pay.
 
Bank or Institution: _______________________________________________________________________________________ 
Routing/Transit Number:  ___________________________ 
Account No:_____________________________________ 
Checking 
Savings   
Other   
I wish to Deposit:  $  _____________    or  
Entire Net Amount  
 
Bank or Institution: _______________________________________________________________________________________ 
Routing/Transit Number:   
___________________________ 
Account No: _____________________________________ 
Checking 
Savings   
Other   
I wish to Deposit:  $  _____________    or  
Entire Net Amount  
 
Bank or Institution: _______________________________________________________________________________________ 
Routing/Transit Number:   
___________________________ 
Account No: _____________________________________ 
Checking 
Savings   
Other   
I wish to Deposit:  $ ______________   or  
Entire Net Amount  
 
Authorization 
I hereby authorize my employer ( hereafter “Company”) to deposit any amounts owed me by initiating credit entries to my account at the financial 
institution(s) (hereafter “Bank”) indicated on this form.  Further I authorize the Bank to accept and to credit any credit entries indicated by the 
Company to my account(s).  In the event the Company deposits funds erroneously into my account, I authorize the Company to debit my account 
for an amount not to exceed the original amount of the erroneous credit.  
The authorization is to remain in full force and effect until the Company and Bank have received written notice from me of it’s termination in such 
time and in such manner as to afford the Company and Bank reasonable opportunity to act on it. 
Employee Name: ________________________________________    
 Social Security No: ____________________________ 
Employee Signature: _____________________________________   
  Date: _______________________________________ 
L. J. Gonzer Associates 
14 Commerce Drive, Cranford, New Jersey 07016 
908.709.9494 (ph) 908.709.9077 (fax) 
https://

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Employee Direct Deposit Enrollment Form Employee Direct Deposit Enrollment Form Business
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