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PAYROLL DIRECT DEPOSIT EMPLOYEE AUTHORIZATION FORM

PAYROLL DIRECT DEPOSIT EMPLOYEE AUTHORIZATION form **PLEASE WRITE LEGIBLY** EmployER Name:_____ EmployeER Client #:_____ EMPLOYEE Name:_____ EMPLOYEE E-mail address for voucher:_____@_____ Account Type (mark one): Checking Savings DEPOSIT Amount (mark one): Entire Percentage of Net Flat Amount per Check Check ____% $_____ I authorize my employer and the financial institution named above to remit my paycheck via ACH.

PAYROLL DIRECT DEPOSIT . EMPLOYEE AUTHORIZATION FORM *****PLEASE WRITE LEGIBLY. EmployER Name:_____ EmployeER Client #:_____ Employee Name:_____

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Transcription of PAYROLL DIRECT DEPOSIT EMPLOYEE AUTHORIZATION FORM

1 PAYROLL DIRECT DEPOSIT EMPLOYEE AUTHORIZATION form **PLEASE WRITE LEGIBLY** EmployER Name:_____ EmployeER Client #:_____ EMPLOYEE Name:_____ EMPLOYEE E-mail address for voucher:_____@_____ Account Type (mark one): Checking Savings DEPOSIT Amount (mark one): Entire Percentage of Net Flat Amount per Check Check ____% $_____ I authorize my employer and the financial institution named above to remit my paycheck via ACH.

2 This also includes my AUTHORIZATION for my employer to reverse any entries that were made in error. This AUTHORIZATION will remain in effect until company receives written notice from me. X EMPLOYEE Signature:_____ Effective Date:_____ **We MUST have a copy of a voided check or a bank provided ACH form in order to process your request. PLEASE ATTACH VOIDED CHECK HERE.

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