Fillable DIRECT DEPOSIT AUTHORIZATION

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DIRECT DEPOSIT AUTHORIZATION

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The DIRECT DEPOSIT AUTHORIZATION form is 1 page long and contains:

  • 1 signature
  • 17 check-boxes
  • 11 other fields

Country of origin: OTHERS
File type: PDF

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DIRECT DEPOSIT AUTHORIZATION
Account Information
A voided check and/or a letter from your financial institution,
which includes the ACH Routing Number and your Bank Account
Number, should be included with your request for each account
to be set up. The sample on the right shows the placement of the
information required to complete this form.
If using a Netspend Skylight Paycard, please enter "'Republic Bank
and Trust Company'" as the Bank Name and enter the Netspend
Skylight routing and account number provided on your paycard.
I authorize Oasis to electronically deposit to the accounts below:
Checking Savings
Add Change
Delete
Pay allocation for this account: Fixed Amount: $
Percentage of Pay: %
Remainder/Balance of Pay
Bank Name:
ACH Routing Number:
(Routing number cannot start with a 5 and must be 9 digits)
Checking Savings
Add Change Delete
Pay allocation for this account: Fixed Amount: $
Percentage of Pay: %
Remainder/Balance of Pay
Bank Name:
ACH Routing Number:
(Routing number cannot start with a 5 and must be 9 digits)
Electronic Pay Stub
You will automatically be enrolled in electronic paperless pay stubs, unless you choose to receive a paper stub by
checking the box below.
I wish to receive paper pay stubs
Changes in banks or banking account information will require immediate notification to the Oasis Payroll
Department and will result in a live check being received for up to two pay periods from the time the change is
received by Oasis. I understand that any changes, including stopping my direct deposit, must be submitted by me
in writing at least one week prior to my next scheduled pay date. I agree that in the event that Oasis erroneously
deposits money into my account, I authorize Oasis to debit my account for an amount not to exceed the original
amount of the erroneous deposit. Should the funds no longer be in my account and these funds were not rightfully
mine, I agree to return the amount of the erroneous deposit in full, upon demand. By signing this form, I agree to all
the conditions and fees imposed by the bank for all actions and exceptions noted above.
Employee Signature Date
Print Name Social Security Number
Client ID:
Employee ID:
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DIRECT DEPOSIT AUTHORIZATION

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Completed 21 March 2022

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