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Direct Deposit Authorization Form

The document is a direct deposit authorization agreement allowing an employee to have their payroll deposited directly into their bank account. It provides fields for the employee to fill in their personal information like name and social security number. It also lists the bank account details including bank name, routing number, account type and number that the deposits will be made to. The employee signs to authorize the direct deposits and provide their contact information, with the agreement remaining in effect until cancelled in writing.

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Rudolph Rushin
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174 views1 page

Direct Deposit Authorization Form

The document is a direct deposit authorization agreement allowing an employee to have their payroll deposited directly into their bank account. It provides fields for the employee to fill in their personal information like name and social security number. It also lists the bank account details including bank name, routing number, account type and number that the deposits will be made to. The employee signs to authorize the direct deposits and provide their contact information, with the agreement remaining in effect until cancelled in writing.

Uploaded by

Rudolph Rushin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Direct Deposit Authorization Agreement

Client Co: _________________________________ 10/ 03 /19


Date: _________________________________

Employee Name (Last, First): ___________________________________ SSN (last 4): ___________________________

I hereby authorize Corporate Solutions to initiate credit entries and any necessary debit entries and adjustments for any credit
entries in error to my account indicated below. I also hereby authorize the depository named below to credit and/or debit
the same to such account.
(If you don't have a check to void, ask your bank for a counter check or irect e osit et or )

Please accept this as your authorization to deposit payroll proceeds into my checking/savings as listed below:

1. Bank Name: ________________________________ Bank Address: __________________________________

Bank’s Routing/Transit Number: ________________ Amt to be deposited (% or $): ______________________

Account Type: Savings Checking Account Number: ________________________________

2. Bank Name: ________________________________ Bank Address: __________________________________

Bank’s Routing/Transit Number: ________________ Amt to be deposited (% or $): ______________________

Account Type: Savings Checking Account Number: ________________________________

3. Bank Name: ________________________________ Bank Address: __________________________________

Bank’s Routing/Transit Number: ________________ Amt to be deposited (% or $): ______________________

Account Type: Savings Checking Account Number: ________________________________

This authorization remain in effect until Corporate Solutions has received


The cancellation request for direct deposit must be
received one (1) week before the next payroll date.

I understand that by signing below verifies that I have read, understand, and agree to abide by Corporate Solutions
policy on direct deposit.

Signature: Date: ____________________________

Printed Name: Phone: ___________________________

(Please attach a sample/voided check to this


authorization.)
Tel (888) 785-4018 Fax (888) 869-9176
www.corpsolpeo.com
Rev.

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