Authorization for Direct Deposit – Employee Form
This authorizes (your Company) through their payroll service, AFI Accounting, Finance & Insurance Services, to send credit entries (and appropriate debit and adjustment entries) electronically, or by any other commercially accepted method, to my account(s) indicated below and to other accounts I identify in the future. Signing this notice authorizes the financial institution holding the Account to post all such entries, but does not make the company, financial institution, or Financial Consulting Unlimited responsible for any incorrect deposits made due to incorrect ABA #’s or account numbers. Please check with your bank
if you are unclear of your ABA# or account numbers. There is a $10 processing fee for incorrect ABA’s or Account number provided to AFI. Initial set-up, and one change in accounts per year, is included. There is a $8 processing fee for additional changes. If you want to initially use 2 accounts, please submit them at the same time. ACCOUNT #1 Account Type (e.g. Checking or Savings) ACCOUNT #2 Account Type (e.g. Checking or Savings)
Employee Bank Name Branch City, State Account Number
Employee Bank Name Branch City, State Account Number
Bank Routing Number (ABA #)
Bank Routing Number (ABA #)
This authorization will be in effect until the company receives a written termination notice from myself and has a reasonable opportunity to act on the notice. If any incorrect information is provided including incorrect account or ABA #’s, Company and/or processor is not responsible for any funds transferred to the wrong account.
SIGNATURE
DATE
PRINTED NAME
EMPLOYEE ID#
ATTACH VOIDED CHECKS OR SAVING DEPOSIT TICKETS HERE
(Use extra page if necessary).