Employee Direct Deposit Enrollment Form
Payroll Manager – Please complete this section and send a copy to ADP for enrollment. (Please print.)
Company Code: _______ Company Name: _____________________________ Employee File Number: ________
Payroll Mgr. Name: ____________________________ Payroll Mgr. Signature: ____________________________
To enroll in Full Service Direct Deposit, simply fill out this form and give to your payroll manager. Attach a voided check for each checking account - not a deposit
slip. If depositing to a savings account, ask your bank to give you the Routing/Transit Number for your account. It isn’t always the same as the number on a savings
deposit slip. This will help ensure that you are paid correctly.
Below is a sample check MICR line, detailing where the information necessary to complete this form can be found.
|: 012345678|: 123456789” 0101
Memo__________________________
Check #
(this number matches the number
in the upper right corner of the
check – not
needed for sign-up)
Checking Account #
Routing/Transit #
(A 9-digit number always between
these two marks)
IMPORTANT! Please read and sign before completing and submitting.
I hereby authorize ADP to deposit any amounts owed me, as instructed by my employer, by initiating credit entries to my account at the financial institution (hereinafter
“Bank”) indicated on this form. Further, I authorize Bank to accept and to credit any credit entries indicated by ADP to my account. In the even that ADP deposits
funds erroneously into my account, I authorize ADP to debit my account for an amount not to exceed the original amount of the erroneous credit.
This authorization is to remain in full force and effect until ADP and Bank have received written notice from me of its termination in such time and in such manner
as to afford ADP and Bank reasonable opportunity to act on it.
Employee Name: Social Security #: __ __ __ - __ __ - __ __ __ __
Employee Signature: Date:
Account Information
The last item must be for the remaining amount owed to you. To distribute to more accounts, please complete another form.
Make sure to indicate what kind of account, along with amount to be deposited, if less than your total net paycheck.
1. Bank Name/City/State: ____________________________________________________________________
Routing Transit #: __ __ __ __ __ __ __ __ __ Account Number: _________________________________
1Checking 1Savings 1Other I wish to deposit: $ _______.____ or 1Entire Net Amount
2. Bank Name/City/State: ____________________________________________________________________
Routing Transit #: __ __ __ __ __ __ __ __ __ Account Number: _________________________________
1Checking 1 Savings 1Other I wish to deposit: $ _______.____ or 1Entire Net Amount
3. Bank Name/City/State: ____________________________________________________________________
Routing Transit #: __ __ __ __ __ __ __ __ __ Account Number: _________________________________
1 Checking 1 Savings 1 Other I wish to deposit: $ _______.____ or 1Entire Net Amount
ATTENTION PAYROLL MANAGER:
Employers must keep each original employee enrollment form on file as long as the employee is using FSDD, and for two years thereafter.
ADP is a registered trademark of ADP of North America Inc.
Full Service Direct Deposit (FSDD) is a service mark of Automatic Data Processing, Inc.
02-184-049 10M Printed in USA ©1999, 1998 Automatic Data Processing, Inc.
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