Fillable PAYROLL DIRECT DEPOSIT EMPLOYEE AUTHORIZATION FORM

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PAYROLL DIRECT DEPOSIT EMPLOYEE AUTHORIZATION FORM

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PAYROLL DIRECT DEPOSIT
EMPLOYEE AUTHORIZATION FORM
******PLEASE WRITE LEGIBLY******
EmployER Name:__________________________________ EmployeER Client #:________
Employee Name:______________________________________
Employee E-mail address for voucher:________________________@__________________
Account Type (mark one): Checking Savings
Deposit Amount (mark one): Entire Percentage of Net Flat Amount per Check
Check ____% $________
I authorize my employer and the financial institution named above to remit my paycheck via
ACH. This also includes my authorization for my employer to reverse any entries that were
made in error. This authorization will remain in effect until company receives written notice
from me.
X Employee Signature:________________________________ Effective Date:___________
**We MUST have a copy of a voided check or a bank provided ACH form in order to process
your request. PLEASE ATTACH VOIDED CHECK HERE:
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PAYROLL DIRECT DEPOSIT EMPLOYEE AUTHORIZATION FORM

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Completed 17 February 2022

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