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Direct Deposit Authorization

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Direct Deposit Authorization

Direct Deposit Authorization


Sample Text: (Formatting does not match the actually Forms)

Direct Deposit Authorization

Date: _________________________

Company/Employer Name: _____________________________________________

Employee Name: __________________

Social Security Number: __________________

As a matter of convenience to our employees, the above named Company/Employer can direct deposit either a portion of or your entire payroll to the financial institution of your choice.

[ ] Please Direct Deposit my entire net payroll check to:

Name of Bank: _______________________________________________________

Branch Address:______________________________________________________

Account Number: _____________________________

Routing Number: _____________________________

I, the undersigned do hereby request the deposit of my entire net payroll check into the above named bank account each pay period. I further authorize the above named Company/Employer to withdraw any funds deposited in error into my account.

IN WITNESS WHEREOF, Company and Employee have executed, entered into and delivered this Agreement as of the date first set forth above.

Employee’s Name: ________________________________________________________________________

By _____________________________________________
Signature Date

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