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
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
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
[ ] I would like to cancel my deposit
authorization. I hereby cancel the
previously submitted authorization for direct deposit and/or payroll deduction
Employee Signature: ________________________ Date: __________________
Please attach a copy of deposit slip.