SEBA Employee Direct Deposit Authorization Agreement
Complete this form to authorize direct deposit of your pay into your designated bank accounts.
Company Name
*
Employee Name
*
Home Address
*
Account 1 Information
Account 1 Type
*
Checking
Savings
Account 1 Amount ($)
Account 1 Amount (Percent %)
Account 1 - Financial Institution
*
Account 1 - Bank Routing Number (ABA Number)
*
Account 1 - Account Number
*
Account 2 Information
(Remainder to be deposited to this account)
Account 2 Type
Checking
Savings
Account 2 Amount ($)
Account 2 Amount (Percent %)
Account 2 - Financial Institution
Account 2 - Bank Routing Number (ABA Number)
Account 2 - Account Number
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of
Authorization Agreement
I hereby authorize Employer, either directly or through its payroll service provider, to deposit any amounts owed me, by initiating credit entries to my account at the financial institution (hereinafter "Bank" indicated on this form). Further, I authorize Bank to accept and to credit any credit entries indicated by Employer, either directly or through its payroll service provider, to my account. In the event that Employer deposits funds erroneously into my account, I authorize Employer, either directly or through its payroll service provider, to debit my account for an amount not to exceed the original amount of the erroneous credit. This authorization is to remain in full force and effect until Employer and Bank have received written notice from me of its termination in such time and in such manner as to afford Employer and Bank reasonable opportunity to act on it.
Employee Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit Authorization
Submit Authorization
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