DIRECT DEPOSIT AUTHORIZATION
I.D. Number: _______________________
S.S. Number: _______-_______-_______
As a convenience to our employees, the Company can direct deposit either a portion of or your entire payroll to the financial institution of your choice. Please note that you are not required to have any portion of your wages deposited directly into a financial institution.
[ ] Yes, Please Direct Deposit my entire net payroll check to:
Bank Name & Branch __________________ Account Number ____________________
I hereby request the deposit of my entire net payroll check into the above named bank account each pay period. I further authorize ___________________________ and _________________________ to withdraw any funds deposited in error into my account.
[ ] Yes, please deposit a portion of my payroll through a Direct Payroll Deduction to:
Bank Name & Branch: __________________ Account Number: ___________________
I hereby request and authorize the sum of ________________ Dollars ($________) to be deducted from my paycheck each pay period, and to be deposited directly into the bank account named above.
I further authorize ________________________ and ________________________ to withdraw any funds deposited in error into my account.
[ ] I would like to cancel my deposit authorization. I hereby cancel the previously submitted authorization for direct deposit and/or payroll deduction deposit .
Employee Signature: ________________________ Date: __________________
Please attach a copy of deposit slip.