Direct Deposit Authorization

Direct Deposit Authorization
I authorize my employer to deposit my wages/salary into the bank accounts specified below. I agree that direct deposit transactions I authorize comply with all applicable law. My signature below indicates that I am agreeing that I am either the accountholder or have the authority to authorize my employer to make direct deposits into the named account. This form along with proper documentation MUST be complete in order to

Be aware that your direct deposit can take up to 4 weeks to activate after the date of receipt.
Employee Full Name*
Employee's Social Security Number*
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Choose one*
Account Number*
BANK NAME*
Routing Number*
Upload picture or File of bank deposit form or voided check
File Upload

Cancelof
Employee Signature*

Clear
Date*

MonthDayYear
Date
REQUIRED: PLEASE PLACE YOUR CANCELLED CHECK WITH YOUR PRINTED NAME ON IT HERE. IF YOU DO NOT HAVE CHECKS FOR THIS ACCOUNT, PLEASE ATTACH. A COPY OF ANY ONE OF THE ACCEPTABLE DOCUMENTS LISTED ABOVE.
Should be Empty:

Upload picture or File of bank deposit form or voided check