Automatic Direct Deposit Request Form

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AUTOMATIC DIRECT DEPOSIT REQUEST FORM
Employee’s Name
Email Address
For a checking account, please attach a voided check.
For a savings account, please write your account number and your bank’s routing number.
Account #1
Name of Financial Institution
Account Number
Routing Number
Account Type
Checking
Savings
Other
Flat Dollar Amount $
OR Flat Percentage
%
Account #2 (if applicable)
Name of Financial Institution
Account Number
Routing Number
Account Type
Checking
Savings
Other
Flat Dollar Amount $
OR Flat Percentage
%
Your paycheck will be automatically direct deposited, 100% of your paycheck must be deposited into
one or a combination of the above account(s).
You will receive a registration email from ADP so you can access your pay stub information at any
time. A paper pay stub will not be sent out.
Employee Signature
Date

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