AUTHORIZATION FOR DIRECT DEPOSIT
REMINDERS
● Provide all information requested completely as possible for all accounts new and old. ● If you are having funds deposited into a checking account, attach a VOIDED BLANK CHECK for the account. ● This form must be signed and dated by the employee to be valid. If not, the direct deposit will not be processed.
Employee Name:
SSN:
Company:
ACCOUNT #1
Account Type:
Checking
Savings
Name of Financial Institution
Routing Number
Account Number
Verify Account Number
I hereby authorize the Company named above, via their payroll service provider (Access1Source-NC,LLC) and the financial institution(s) named above to deposit my pay automatically to the specified accounts. Adjusting entries to correct errors are also authorized. Please continue this authorization until I cancel it in writing.
Upload Copy/Copies of Voided Check(s)
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