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Direct Deposit Enrollment Form
To enroll in Full Service Direct Deposit, simply fill out this form and give to your payroll manager. Attach a voided check for each checking acsount - not a deposit
slip. 1f depositing to a savings acvount, ask your bank to give you the Routing/Transit Number for your account. It isn’t always the same as the number on a savings
deposit slip. This will help ensure that you are paid correctly.
Below is a sample check MICR line, detailing where the information nccessary to complete this form can be found.
Routing/Transit # | \ Check #
(A 9-digit number always between Checking Account # (this atmber matches the number
these two marks) in the upper right comer of the
check — not needed for sign-up)
Important! Please read and sign before completing and submitting.
Thereby authorize my employer (hereinafter “Company”) to deposit any amounts owed me by initiating credit
entries to my account at the financial institution(s) (hereinafter “Bank”) indicated on this form. Further, I authorize
Bank to accept and to credit any credit entries indicated by Company to my accounts. In the event that Company
deposits funds erroneously into my account, I authorize Company 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 Company and Bank have received written notice from
me of its termination in such time and in such manner as to afford Company and Bank reasonable opportunity to act
on it.
Employee Name:
Employee Signature: Date:
Account Information
You may choose up to three accounts.
1. Bank Name
Routing Transit#: Account Number:
Checking OSavings __Entire Net Amount I wish to deposit: $
2. Bank Name
Routing Transit#: Account Number:
OcChecking O Savings ___Entire Net Amount I wish to deposit: $
3. Bank Name
Routing Transit # Account Number:
Checking © Savings ___Entire Net Amount I wish to deposit: $