Direct Deposit

Employee Direct Deposit/Bank Account Initiation Change Form

This form is to be used for employees new to Direct Deposit. This form may also be used for employees changing the account(s) to which their paycheck is deposited.

Employee Instructions: Complete the following required information:
Employee Name
Social Security Number
I do not want direct deposit. I would like a: Paper Check

I would like my entire net pay deposited to the following Bank Account: One of the following must be attached (check one}:

Bank letter or specification sheet(See your local bank representative
Choose payment option
I do not want direct deposit. Skip direct deposit and sign
Complete for Direct Deposit
Bank Name
Account Number
Routing Number
One of the following must be attached (check one}: or
Upload

Cancelof
Employee Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Choose payment option