American Lane, Schaumburg, IL | BATClientSupport@paylocity.com | Copyright © Paylocity. All Rights Reserved.
BANKACCOUNTINFORMATION
Account Number:
Bank ACH Routing Number:
Bank/Financial Institution:
Branch: City: State:
ELECTRONIC FUNDS TRANSFER
ACCOUNTHOLDERINFORMATION
Name: Company:
COMPANYIDs
1431696316 2431696316 3431696316 4431696316 5431696316
The authority will remain in full force and effective until Paylocity has received written notification from me of its termination in such time and in such manner as to afford
Paylocity a reasonable opportunity to act on it. I also understand by signing this, I am verifying I understand I am responsible for the accuracy of the initial information
and the updating of these subsequent fields (i.e. changing bank accounts, bank name changes, etc.).
Signature: Date:
I hereby authorize Paylocity to initiate variable debit entries to my (check one): Checking Account Savings Account
indicated below and my financial institution named below to debit the same to such account.
Please submit this form to Paylocity via secure email batinfo@paylocity.com or fax.
MUST ATTACH VOIDED CHECK!
*Electronic Funds Transfer only processed with a copy of a voided check on file.*
ACH Bank Filters
Paylocity has multiple Company IDs that are required to be given to your bank when setting up ACH transactions. If your bank account is not
setup with the appropriate Company IDs, ACH transactions may be rejected.
It is important to add the following Company ID’s to your bank account(s) prior to Paylocity initiating your rst banking transaction. Your rst
transaction may include your Debit Card pre-fund, if applicable. Additional fees may apply if banking transactions are returned to Paylocity.
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