Authorization for Employer from Employee

Document Sample
Authorization for Employer from Employee Powered By Docstoc
					                  EMPLOYEE DIRECT DEPOSIT AUTHORIZATION


Name of Financial Institution_____________________________________

Branch (City                                    Checking ( C )
And State)______________________________________Savings ( S )____

I understand that in the event my employer notifies my financial institution that I am not entitled to the
funds deposited to my account, my bank is authorized to debit my account for the amount of the
adjustment.




                                Please staple to the original form a Voided
                   Check (Checking Account) or a Deposit Slip (Savings Account) for your
                                     financial institution and account




Signed_________________________________Date_________SS#_________________
            Employee’s Full Name

________________________________________________________________________
________________________________________________________________________


To be completed by the Agency Payroll Section:

             Bank Routing                                                          Checking ( C )
             (ABA) Number                      Bank Account Number                 Savings ( S )

             _________                         _____________                                _

Employee direct deposit information in the Payroll System has been verified.


Initialed by _____________Date____________                       AGY_________PAY_______ACT_______
REVISED 1-16-01

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:7
posted:1/20/2012
language:English
pages:1
Description: Authorization for Employer from Employee document sample