This Direct Deposit Authorization form can be used by companies to authorize direct
account depositing of funds of their employees. This form obtains the necessary
information to complete a direct deposit transaction, such as bank name, account
number and routing information. Direct deposit offers a convenient method for
employees to receive their paychecks without having to deposit them in person.
DIRECT DEPOSIT AUTHORIZATION
TO: (the “Company”)
FROM: (the “Employee”)
SOCIAL SECURITY NUMBER:
RE: Direct Deposit Authorization for Paychecks
THE EMPLOYEE HEREBY AUTHORIZES AND DIRECTS THE COMPANY, to
deposit the Employee’s Paychecks into the Employee’s bank account at the following banking
Telephone Number: Fax Number:
Branch Number: Routing Number:
Account Number: Checking:____ Savings:__________
Effective Date: _____________________________
THIS AUTHORIZATION SHALL REMAIN IN FULL FORCE AND EFFECT UNTIL
CANCELLED BY THE EMPLOYEE IN WRITING.
DATED this _____ day of _____________________, 2________.
Witness: Employee Signature
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