DIRECT DEPOSIT AUTHORIZATION
NOTE: All payments to you from [COMPANY] will be deposited into the same account at your financial institution. Verify with your financial institution on your pay date that your direct deposit has gone into effect— the institution name will not appear on your earnings statement. Background Information Full Legal Name: Telephone Number: ( ) Fax Number: ( ) E-mail Address:
Street Address:
City, State, Zip Code:
Social Security Number:
Financial Institution Bank Name: Branch:
Routing Transit Number:
Customer Account Number:
Account Type: Checking Savings
Deposit Type: Balance Flat Amount: $_____________ Percentage of Net Pay ________ %
Signature and Authorization I authorize [COMPANY] to initiate accounting transactions to deposit my employee payroll check, [travel advances], [and/or] [reimbursements] directly to the bank account(s) indicated above and to correct any errors that may occur from these transactions. I also authorize the financial institution to post these transactions to these accounts. This authorization is to remain in force until the [CO