Employee Direct Deposit Enrollment Form printable pdf download

Employee Direct Deposit Enrollment Form

Important! Please read and sign before completing and submitting.

I hereby authorize Paylocity 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 Paylocity to my account. In the event

that Paylocity deposits funds erroneously into my account, I authorize Paylocity 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 Paylocity and Bank have received written notice from me of its termination in such time and in

such manner as to afford Paylocity and Bank reasonable opportunity to act on it.

Employee Name: __________________________________________ Social Security #: __ __ __ - __ __ - __ __ __ __

Employee Signature: ______________________________________ Date: ____________________________________

Account Information

The last item must be for the remaining amount owed to you. To distribute to more accounts, please complete another form.

Make sure to indicate what kind of account, along with amount to be deposited, if less than your total net paycheck.

1. Bank Name/City/State: Routing/Transit #: __ __ __ __ __ __ __ __ __ Account Number: ___________________________________________