Direct Deposit Authorization Form
To enroll in direct deposit at no charge, just complete sections one through four of the direct deposit enrollment form and attach a voided check for verification of all
financial institution information. Once complete, submit the form and voided check to Manpower. The form gives Manpower authority to deposit your pay into the
specified account. All information is considered personal and will be used by our Payroll department only.
SECTION ONE: EMPLOYEE INFORMATION
Social Security Number: Last Name: First Name:
SECTION TWO: FINANCIAL INFORMATION
If you wish to have your funds deposited into more than one account please contact your Manpower representative and request a copy of the Direct
Deposit Multiple Account Authorization Form.
Financial Institution Address of Financial Institution: City: State: Zip Code:
Savings Account Number Transit ABA Number Bank Phone Number
ADD CHANGE AMOUNT CANCEL
SECTION THREE: ATTACH VOIDED PERSONAL CHECK HERE
ATTACH VOIDED PERSONAL CHECK HERE.
SECTION FOUR: EMPLOYEE AUTHORIZATION & SIGNATURE
I hereby authorize my employer to initiate credit entries to my account as indicated above. If funds to which I am not entitled are deposited in my account, I authorize
my employer to direct the institution to return said funds. This authority is to remain in effect until the company has received timely written notice from me of
termination. I understand I am responsible for the validity of the information on this form and for keeping my employer aware of all changes in banking arrangements.
Employee Signature (Fax signature is considered as original) Date
SECTION FIVE: INTERNAL USE ONLY
Business Unit Number: Office #: AOS/FPB Order Number: AOS/FPB Assignment Number: