Employee Direct Deposit Enrollment Form printable pdf download

Employee Direct Deposit Enrollment Form

Payroll Manager Please complete this section and send a copy to ADP for enrollment. (Please print.)

Co m pany Code: _______ Co m pany N a m e:________________________________________ Date: ____________________

Payroll M gr. N a m e: __________________________________ Payroll M gr. Signature: _____________________________

To enroll in Full Service Direct Deposit, simply ﬁll out this form and give it to your payroll manager. Attach a voided check

for each checking account–not a deposit slip. If depositing to a savings account, ask your bank to give you 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.

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

Memo

012345678

123456789

0101

Check #

Routing/Transit #

Checking Account #

(this number matches the number in

(A 9-digit number always

the upper right corner of the check

between these two marks)

not needed for sign-up)

mportant! Please read and sign before completing and submitting.

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”) indicated on this form. 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 errone-

ously into my account, I authorize Company 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 Company and Bank have received written notice from me

of its termination in such time and in such manner as to afford Company and Bank reasonable opportunity to act on it.

Employee Name: __________________________________________

Social Security #: __ __ __ - __ __ - __ __ __ __

Employee Signature: ______________________________________

Date: ____________________________________

Account nformation

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: ___________________________________________

I wish to deposit: $ ________ . ____

Checking

Savings

Other

Entire Net A mount

2. Bank Name/City/State:

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

Account Number: __________________________________________

I wish to deposit: $ ________ . ____

Checking

Savings

Other

Entire Net A mount

3. Bank Name/City/State:

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

Account Number: __________________________________________

I wish to deposit: $ ________ . ____

Checking

Savings

Other

Entire Net A mount

ATTENT ON PAYROLL MANAGER:

Employers must keep each original employee enrollment form on ﬁle as long as the employee is using FSDD,

and for two years thereafter.

Employee Direct Deposit Enrollment Form

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