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Direct Deposit Authorization
DIRECT DEPOSIT AUTHORIZATION
Name [Name of Employee]
I.D. # [I.D. of Employee]
S.S.N. [S.S.N. of Employee]
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 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.