Free Direct Deposit Authorization

This Direct Deposit Authorization Form authorizes an employer to have an employee’s salary sent directly to a specific bank account. This authorization sets out the name of the bank, account and routing numbers, type of account and the amount of salary to be deposited. This Direct Deposit Authorization Form must be accompanied by a voided check and signed by the employee.

Disclaimer:This was not drafted by an attorney & should not be used as a legal document.




DIRECT DEPOSIT AUTHORIZATION FORM

Date:____________________________
Name:___________________________
ID#_____________________________

Type of Payroll: _____________________
I, hereby request and authorize _____________________________ to deposit my pay to the account and bank indicated below. This authority will remain in effect until I have given written notice of termination or until company has notified me that this service has been discontinued.
Name of Bank ________________________________
Account # ____________________________________
Routing # ____________________________________
Type of Account: ______________________________
Amount: $____________________________________

Signature:________________________________________
In order to sign up for direct-deposit, you must attach a copy of a personal check. For security reason, we recommend that it is cancelled or marked void

PLEASE STAPLE A COPY OF YOUR CHECK HERE
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