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:________________________@__________________
**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:
Account Type (mark one): Checking
Savings
Deposit Amount (mark one): Entire Check
Percentage of Net ____%
Flat Amount per Check $________
I authorize my employer and the financial institution named above to remit my paycheck via ACH. 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:___________
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