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(Company Name) : Direct Deposit Agreement Form

I authorize [Company Name] to directly deposit my pay into my checking or savings account and to withdraw any deposits made in error. This agreement stays in effect until canceled in writing or if I submit a new direct deposit form. I will not hold [Company Name] responsible for delays or losses due to incorrect information from me or my bank or from bank errors depositing funds into my account.

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kelodsjk
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50 views1 page

(Company Name) : Direct Deposit Agreement Form

I authorize [Company Name] to directly deposit my pay into my checking or savings account and to withdraw any deposits made in error. This agreement stays in effect until canceled in writing or if I submit a new direct deposit form. I will not hold [Company Name] responsible for delays or losses due to incorrect information from me or my bank or from bank errors depositing funds into my account.

Uploaded by

kelodsjk
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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[Company Name]

Direct Deposit Agreement Form

Authorization Agreement

I hereby authorize [Company Name] to initiate automatic deposits to my account at the financial
institution named below. I also authorize [Company Name] to make withdrawals from this account in
the event that a credit entry is made in error.

Further, I agree not to hold [Company Name] responsible for any delay or loss of funds due to
incorrect or incomplete information supplied by me or by my financial institution or due to an error on
the part of my financial institution in depositing funds to my account.

This agreement will remain in effect until [Company Name] receives a written notice of cancellation
from me or my financial institution, or until I submit a new direct deposit form to the Payroll
Department.

Account Information

Name of Financial Institution:


Routing Number:

Account Number: ☐ Checking | ☐ Savings

Signature

Authorized Signature (Primary): Date:


Authorized Signature (Joint): Date:

Please attach a voided check or deposit slip and return this form to the Payroll Department.

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