Authorization Form For Direct Deposit
Download a blank fillable Authorization Form For Direct Deposit in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Authorization Form For Direct Deposit with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1New Hire / Enrollment (Note: Pre-notification
takes 5 business days once received in Payroll)
Change
Cancel (change in banks only – attach new
enrollment form for new bank). Note: cancel
occurs immediately. Next pay will be actual
check until new enrollment takes effect.
Authorization Form for Direct Deposit
Documentation required for Direct Deposit
Checking Account: Blank, voided check with employee name preprinted on check, monthly
statement or letter from bank that includes bank name, employee name, account number and
ABA/Routing number.
Savings Account: Monthly statement, copy of passbook or letter from bank that includes bank
name, employee name, account number and ABA/Routing number.
Documentation is required for changes (with the exception of dollar amount to existing direct
deposit accounts).
For Hartford Federal Credit Union, you must contact them directly.
I request that my partial or net pay be deposited at:
_________________________________
______________________________________
Name of Financial Institution
Employee Name
__________________________________
_____________________________________
Address of Financial Institution
Employee Number
__________________________________
______________
____________________
City, State, Zip
Dept. Number
Dept. Name
__________________________________
_____________________________________
American Banking Assoc./Routing #
Employee Phone Number
Deposit to
Account Number
Dollar Amt.
Deposit to
Account Number
Dollar Amt.
Checking
_______________
$_______
Savings
_______________
$_______
Checking
_______________
$_______
Savings
_______________
$_______
Authorization Agreement for Direct Deposit
I hereby authorize the direct deposit of my partial or net pay by my employer in the account(s)
to the financial institution(s) as indicated on this form. Such direct deposit will be made on
each succeeding payday unless I choose to terminate this agreement in writing to my
employer. Any such notification to my employer shall become effective following receipt,
after a reasonable opportunity to act on it.
In the event that my employer deposits funds erroneously into my account, I authorize my
employer to debit my account for an amount not to exceed the original amount of the credit.
___________________________________________
______________________
Employee Signature
Date
I agree that my signature above is sufficient for this verification form.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial