DIRECT DEPOSIT AUTHORIZATION

 

Name: _______________________

 

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.