Direct Deposit Online Form

You will be required to accept the above listed Terms & Conditions below.
YOUR PERSONAL INFORMATION PROTECTED BY COMPLETE SECURITY ENCRYPTION
The areas above are a photo. You are required to fill-out the lines below that correspond to this photo. You will not be able to submit form until all REQUIRED* fields are correctly filled-in.
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail (THIS IS WHERE YOUR PAY STUBS WILL BE SENT!)
#1 Write NAME of BANK / CREDIT UNION or PRE-PAY DEBIT CARD COMPANY in the box below.
NAME OF BANK/CU/DEBIT*
#2 Write the ROUTING NUMBER of your CHECKING OR SAVINGS ACCOUNT or PRE-PAY DEBIT CARD ROUTING NUMBER in the box below.
ROUTING NUMBER*
#3 Write the ACCOUNT NUMBER of your CHECKING OR SAVINGS ACCOUNT or DEBIT CARD in the box below.
ACCOUNT NUMBER*
#4 Select the TYPE of ACCOUNT below. DEBIT ACCOUNTS are usually "CHECKING".
TYPE OF ACCOUNT*
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#5 DEPOSIT OPTIONS. You can choose to deposit the ENTIRE paycheck, or a DOLLAR AMOUNT portion of your net pay into your account.
#5 - PLEASE MAKE ONLY ONE SELECTION!

CHOOSE EITHER: 5A OR 5B!
#5A CHOOSE DEPOSIT ENTIRE AMOUNT OR 5B TO ENTER PORTION*
OR #5B WRITE IN PORTION AMOUNT OF CHECK TO DEPOSIT EACH CHECK
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Terms & Conditions (PART 1)*

I (we) hereby authorize and request the COMPANY, to make payment of any amounts owing to me (either of us) by initiating credit entries to my (our) account indicated above in the bank named above, hereinafter called BANK, and I (we) authorized and request BANK to accept any credit entries initiated by COMPANY to such account and to credit the same to such account without responsibilty for the correctness thereof.
Terms & Conditions (PART 2)*

I (we) authorize and request COMPANY to effect repayment to COMPANY for amounts owed it because of prior erroneous credit initiated bo my (our) account if prior to the correcting entry, the COMPANY has sent or delivered to me written notice of the correction and the reason therefore; and the correcting entry is transmitted in such time as to be delivered or made available to BANK before midnight of the tenth day next following settlement for the erroneous entry.
Terms & Conditions (PART 3)*

It is understood that this agreement may be terminated by me (either of us) at any time by written notification to COMPANY or BANK. Any such notification to COMPANY shall be effective only with respect to entries initiated by COMPANY after receipt of such notification and a reasonable opportunity to act on it. Any such notification to BANK shall be effective only with respect to entries credited to my (our) account by BANK after receipt of such notification and a reasonable time to act on it.
Terms & Conditions (PART 4)*

I (we) recognize, acknowledge and accept this service is being provided for my (our) convenience. As such, I (we) agree to hold the COMPANY, AIU Payroll, Inc., each participating bank and NACHA harmless from any claim incident to the operation of this plan, arising from any act or omission by the COMPANY and/or AIU Payroll, Inc. and their employees, including without limitation any claim based on alleged loss as a result of non-credit of any deposit, and any claim which may be made by any depsoitor as a result of the rejection of any of his/her debits because of insufficient funds arising from the failure to credit deposits to his/her account.
#6 EMPLOYEE NAME*
#7 EMPLOYEE SIGNATURE*
#8 DATE EMPLOYEE SIGNED*

MonthDayYear
#9 CO-OWNER'S NAME (REQUIRED FOR ANY NAME LISTED ON ACCOUNT BESIDES EMPLOYEE)
#10 CO-OWNER'S SIGNATURE
#11 CO-OWNER DATE SIGNED

MonthDayYear
#12 IF YOU CURRENTLY HAVE AN ACTIVE DIRECT DEPOSIT, PLEASE SELECT CANCEL
IMPORTANT: WE ARE RECEIVING TOO MANY INCOMPLETE DIRECT DEPOSIT FORMS!

YOUR DIRECT DEPOSIT FORM IS NOT COMPLETE UNTIL YOU DO ONE OF THE FOLLOWING:

1. ATTACH a VOIDED check OR Direct Deposit FORM from your bank, credit union, green dot, etc. (See attach below this section)

2. IF you do NOT know how to do an attachment, take a PHOTO of your VOIDED CHECK or DIRECT DEPOSIT FORM and TEXT that photo to 561-542-7571(Ed Tramazzo/Office Mgr).

PLEASE CALL ONLY 561-419-8224 or TEXT ONLY me a message to 561-542-7571 if you have ANY questions about how to do any of these tasks...we are here to help!

MUST HAVE ONE OF THESE ASAP when filling out this form or you will not have direct deposit!
UPLOAD FILE OF A PDF OR SCAN OR PHOTO OF ONE OF THE FOLLOWING TYPES OF UPLOADS 1. CHECK WITH VOID WRITTEN ON IT OR 2. PRE-FILLED FORM FROM YOUR BANK, INSTITUTION, OR CARD OR 3. PHOTO OF YOUR VOIDED CHECK (LAST RESORT PLEASE!)

Upload a File

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You will be required to accept the above listed Terms & Conditions below.

The areas above are a photo. You are required to fill-out the lines below that correspond to this photo. You will not be able to submit form until all REQUIRED* fields are correctly filled-in.