Fillable Payroll Payment Option Form printable pdf download

PAYROLL PAYMENT OPTION FORM

St. Edward’s employees have two options to receive payment of wages. Please select only one of the following:

DIRECT DEPOSIT

To enroll in direct deposit, simply fill out this form and send it to Payroll, campus mail 1042. Attach a voided check for each checking

account – not a deposit slip. If depositing to a savings account, ask your bank to give you a bank specification sheet with 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.

Account Information

Below is a sample check detailing where the information necessary to complete this form can be found.

You may choose up to two accounts. (Your last item must be for the remaining amount owed to you.)

Bank Name/City/State: _________________________________________________________________________________________

Routing/Transit #: __ __ __ __ __ __ __ __ __

Account Number: _________________________________________________

□ Checking

□ Savings

□ Entire Net Amount

I wish to deposit: $ ________.____

Bank Name/City/State: _________________________________________________________________________________________

Routing/Transit #: __ __ __ __ __ __ __ __ __

Account Number: _________________________________________________

□ Checking

□ Savings

□ Entire Net Amount

I wish to deposit: $ ________.____

(sign and complete signature section below)

PAY CARD

Your wages will be deposited into a payroll card account that can be accessed using a pay card. The funds will be held in a bank trust account

that is FDIC insured. You will not earn interest on your funds. The pay card functions like a debit card allowing you to access your money at

ATMs, any where MasterCard is accepted, (for purchases and cash back), via Comchek drafts or at any MasterCard bank. The system provides

for one free transaction after each deposit of funds, but certain fees apply for additional transactions, as disclosed in the pay card materials

provided to you.

Pay Card#

___ ___ ___

___ ___ ___ ___ (to be completed by Payroll)

Check here if this form is being provided for special use and is not intended to replace automatic deposit information for ongoing

payroll payments.

(sign and complete signature section below)

Important! All employees please read and sign before completing and submitting.

For the Direct Deposit option, I hereby authorize my employer (hereinafter “Company”) to deposit any amounts owed me by initiating credit

entries to my accounts at the financial institutions (hereinafter “Bank”) listed above. Further, I authorize Bank to accept and to credit any credit

entries indicated by Company to my accounts. In the event that Company deposits funds erroneously into my account, I authorize Company to

debit my account for an amount not to exceed the original amount of the erroneous credit.

For the Payroll Card option, I consent to receive my wages by electronic transfer to my payroll card. I acknowledge that I have received a copy

of the Consent Form and a schedule of the fees I will incur using my card. I have read, understand and agree to all of the terms applicable to the

payroll card.

This authorization is to remain in full force and effect until Company and Bank have received written notice from me of its termination in such

ompletion of this

time and in such manner as to afford Company and Bank reasonable opportunity to act on it. I acknowledge that the c

form will void any previously selected payroll payment options.

Employee Name: __________________________________________ SEU ID #

Employee Signature: _______________________________________ Date: ____________________________________

HUMR\HR Forms\Employment Documents\Payroll Payment Option Form 4-13-11

Payroll Payment Option Form

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