ACH DIRECT DEPOSIT OF PAYROLL AUTHORIZATION AGREEMENT
I hereby authorize _______________________________________________ to initiate credit entries or such adjusting entries, either debit or credit which are necessary for corrections, to my Checking or Savings account indicated below and the financial institution(s) named below to credit (or debit) the same to such account.
PLEASE PRINT CLEARLY
Name of Financial Institution City State Bank Transit/
Routing Number
Account Number Account Type
(Checking or Savings)
Percentage
or Dollar Amount
             
             
             
             
             

If paycheck is to be sent to more than one financial institution, then you must indicate the dollar amount or percentage of contribution to each financial institution.
If you would like only part of your paycheck direct deposited, then you must indicate the dollar amount that you want direct deposited to your financial institution. You will then receive the balance of your pay via a check.

For direct deposit to a checking account, please attach a voided check. For direct deposit to a savings account, please attach a voided deposit slip.


     
__________________________________
   
 EMPLOYEE NAME
     
__________________________________
   
 SIGNATURE

        __________________________________
   
    SOCIAL SECURITY NUMBER
       
__________________________________
   
    DATE


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