Authorization Agreement For Automatic Deposits Form Page 2
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2AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITS
Please read this form carefully and write clearly.
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If this is a new account, you must:
1. Already have the account set up at your bank.
2. Find out if they accept direct deposits. Verify your bank’s transit # and your
account # (include dashes).
3. Notify the bank that you are going to set up direct deposit through Payroll. Make
sure that there isn’t anything special you need to do as far as your bank is
concerned.
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Please check the action and complete below:
_____ Canceling account (complete item C below). Do not close and account unless you
cancel it through Payroll first.
_____ Direct deposit already set up, changing $ amount only (complete C through E
below).
_____ A new account (complete A through E below).
_____ A new account to replace a direct deposit already set up (complete A through E
below). Which account are you replacing?_______________________________
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A. Bank Name:__________________________________________________________
B. Bank TBA #:
/_____/_____/_____/_____/_____/_____/_____/_____/_____/
C. Bank Account #:
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
D. Checking:______________________
Savings:_____________________________
Full Deposit:____________________ Partial Deposit (amt per payroll)__________
Please return this form to the Payroll Department with a voided check from your
checking account or a deposit slip from your savings account.
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_____ I authorize ADP and the bank listed above to direct my net pay or portion thereof
as indicated above into my account each payday.
_____ If funds to which I am not entitled are deposited to my account, I authorize ADP
to direct the bank to return said funds.
_____ I understand that deposits are made electronically by ADP, Inc. Deposit to your
designated account(s) requires three (3) “banking days” from the date of payroll
information is received by ADP from our Accounting Department. With respect
to hourly employees paid weekly, we submit payroll information each
Wednesday, therefore, the actual deposit to your account(s) will occur the
following Friday. Should a bank holiday fall on Thursday or Friday, deposits will
be the following Monday. With respect to salaried employees paid semi monthly,
deposit to your designated account(s) will occur by 5:00 p.m. on the pay date
indicated on your check voucher.
Print Name:____________________________________
File #:__________________
Employee Signature:_____________________________
Date:___________________
Social Security Number:__________________________
Dept #:_________________
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