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AUTHORIZATION AGREEMENT FOR AUTOMATIC …

AUTHORIZATION AGREEMENT FOR. AUTOMATIC payroll direct DEPOSITS. Requirements: 1. The account must be established and active at your bank/credit union 2. Confirm the bank accepts direct deposits and verify the bank transit routing and account numbers 3. For savings accounts, you MUST confirm the bank routing number with your financial institution 4. If required, notify the bank that you are going to set up direct deposit through payroll 5. Each employee is allowed up to (4) direct deposit transactions Please check the appropriate box and complete: [ ] Canceling account payroll MUST CANCEL direct DEPOSIT BEFORE YOU CANCEL. ACCOUNT. [ ] New account (Complete Item A through D Below). [ ]Replace an existing direct deposit (Complete Item A through D below). ACCOUNT A: I. Bank Name: II. Transit Routing Number: III. Bank Account Number: IV. Account Type: Checking: Savings: V. Deposit Amt: $. VI. Net payroll : ACCOUNT B: I. Bank Name: II. Transit Routing Number: III. Bank Account Number: IV.

Created by Marcy Aranda H:\Schaumburg HR\New Hire Paperwork\Schaumburg Direct Deposit.doc AUTHORIZATION AGREEMENT FOR AUTOMATIC PAYROLL DIRECT

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Transcription of AUTHORIZATION AGREEMENT FOR AUTOMATIC …

1 AUTHORIZATION AGREEMENT FOR. AUTOMATIC payroll direct DEPOSITS. Requirements: 1. The account must be established and active at your bank/credit union 2. Confirm the bank accepts direct deposits and verify the bank transit routing and account numbers 3. For savings accounts, you MUST confirm the bank routing number with your financial institution 4. If required, notify the bank that you are going to set up direct deposit through payroll 5. Each employee is allowed up to (4) direct deposit transactions Please check the appropriate box and complete: [ ] Canceling account payroll MUST CANCEL direct DEPOSIT BEFORE YOU CANCEL. ACCOUNT. [ ] New account (Complete Item A through D Below). [ ]Replace an existing direct deposit (Complete Item A through D below). ACCOUNT A: I. Bank Name: II. Transit Routing Number: III. Bank Account Number: IV. Account Type: Checking: Savings: V. Deposit Amt: $. VI. Net payroll : ACCOUNT B: I. Bank Name: II. Transit Routing Number: III. Bank Account Number: IV.

2 Account Type: Checking: Savings: V. Deposit Amt: $. VI. Net payroll : Created by Marcy Aranda H:\Schaumburg HR\New Hire Paperwork\Schaumburg direct Page 2 of 2. ACCOUNT C: I. Bank Name: II. Transit Routing Number: III. Bank Account Number: IV. Account Type: Checking: Savings: V. Deposit Amt: $. VI. Net payroll : ACCOUNT D: I. Bank Name: II. Transit Routing Number: III. Bank Account Number: IV. Account Type: Checking: Savings: V. Deposit Amt: $. VI. Net payroll : Please return this completed form to the HR Department, with a voided check for checking, or a deposit slip with the bank's routing number for savings accounts. EACH NEW ACCOUNT MAY TAKE TWO payroll PERIODS KNOWN AS A PRE-NOTE . I authorize Mercury Products Corp. payroll provider and the bank(s) listed to deposit my net pay as indicated into my account(s) each payday If funds to which I am not entitled are deposited to any of the above accounts, I authorize Mercury Products Corp. and their payroll provider to reverse the deposit and direct the bank(s) to return said funds.

3 Employee Name (Print): Employee Signature: Employee Number: Date: Created by Marcy Aranda H:\Schaumburg HR\New Hire Paperwork\Schaumburg direct


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