DIRECT DEPOSIT AUTHORIZATION FORM

DIRECT DEPOSIT AUTHORIZATION FORM

This form is for employees of Uday K Patel CPA LLC's clients. Please provide the following information to get enrolled in direct deposit and to access paystubs and W-2s, and to verify that your personal information is accurately recorded in our system.
Employer Company Name *
Name of your employer's company ( - please ask them if unsure.
Your First Name *
Your Last Name *
Your Email Address *
Must be a valid email address, or you will be unable to view paystubs and W-2s.
I authorize my employer (company named in the first field above) and Uday K Patel CPA LLC to deposit my pay automatically to the account(s) indicated below and, if necessary, to adjust or reverse a deposit or request a refund from me for any payroll entry made to my account in error. This authorization will remain in effect until I cancel it in writing and in such time to afford my employer and Uday K Patel CPA LLC a reasonable opportunity to act on this cancellation.
BANK INFORMATION
Name on Bank Account *
Account Number *
Routing Number *
Account type *

Checking Savings
Please upload a void check for verification of the above bank account.

Cancel of
Do you want to deposit your entire paycheck into the above account? *

Yes No, split it among two methods (continue for options)

SECOND BANK INFORMATION

Since you selected no in the previous screen, please complete the following.
If you answered no to the previous question, please specify the amount you want to deposit to the first bank account:
2nd Bank: Name on Bank Account *
2nd Bank: Account Number *
2nd Bank: Routing Number *
2nd Bank: Account type *

Checking Savings
Please upload a void check for verification of the above bank account.

Cancel of

VERIFICATION and CERTIFICATION by Employee
Make sure you verify your entered information for accuracy; do not submit this form without verification. You certify the following by electronically signing this form:

"Uday K Patel CPA LLC is not liable for any incorrectly submitted information in this form. I understand that incorrectly entered information may result in various issues regarding my payroll. Additionally, my employer is not liable to resolve any issues that arise in the case that I provide the incorrect banking information and the payment processes to the wrong bank account."
Signature *

Clear
Date

Month Day Year
Date
Should be Empty:

BANK INFORMATION