Paycor Direct Deposit Form

PAYCOR DIRECT DEPOSIT WORKSHEET
Paycor Client Name: INSTRUCTIONAL CONNECTIONS LLC
Academic Coach - Full, Legal Name*

First NameMiddle NameLast Name
New (New/First Time Providing Direct Deposit Info)Existing (Changing Direct Deposit Info previously provided)
Account One (1)

You will need to provide a Voided Check or Bank Letter showing the Account Type, Routing Number, and Account Number for all account(s) listed below.
CheckingSavings
Amount (%) to be Deposit to Account One (If Full Net, Indicate 100%)
Percentage (%) - If less than 100%, additional Account(s) will be required.
Amount ($) to be Deposit to Account One
Specific Dollar Amount ($)
Bank Name*
Name on Account*
Account Holder's Name
Routing Number*
9 Digits
Account Number*
Acct #1: Voided Check or Bank Letter confirming all account information:*

Voided Check or Bank Letter
Cancelof
Account Two (2)
CheckingSavings
Amount (%) to be Deposit to Account #2
Percentage (%)
Amount ($) to be Deposit to Account #2
Specific Dollar Amount ($)
Bank Name
Name on Account
Account Holder's Name
Routing Number
9 Digits
Account Number
Acct #2: Voided Check or Bank Letter confirming all account information:

Voided Check or Bank Letter
Cancelof
Account Three (3)
CheckingSavings
Amount (%) to be Deposit to Account #3
Percentage (%)
Amount ($) to be Deposit to Account #3
Specific Dollar Amount ($)
Bank Name
Name on Account
Account Holder's Name
Routing Number
9-Digits
Account Number
Acct #3: Voided Check or Bank Letter confirming all account information:

Voided Check or Bank Letter
Cancelof
I authorize Paycor, Inc., acting on behalf of my employer, to initiate electronic credit entries and, if necessary, debit entries to reverse erroneous credit entries to my account(s It is agreed that these deposits will be made in accordance with the rules of the National Automated Clearing House Association (NACHA This authorization will remain in effect until Paycor, Inc., has received written notification from me of its termination in such time and in such a manner as to afford Paycor, Inc. and the bank a reasonable opportunity to act upon the termination request.
Date*

MonthDayYear
Date
Employee/Contractor Signature*
To be retained by Employer. Keep in your employee files. This form may be photocopied.

Copyright © Paycor Inc. All Rights Reserved
Should be Empty:

PAYCOR DIRECT DEPOSIT WORKSHEET

Account One (1)

Account Two (2)

Account Three (3)