Authorization for Direct Deposit - Free Legal Forms and Contracts

This free legal form and contract is provided as is and should be used for information, sample and example purposes only. Always consult your attorney. It is a valid legal document.

DIRECT DEPOSIT AUTHORIZATION

Full Legal Name: ______________________________________

Identification Number: ______________________________________

Social Security Number: ______________________________________

Bank Name/Branch: ______________________________________

Account Number: ______________________________________

Check the appropriate item:

_____ Direct deposit.

The undersigned hereby requests and authorizes the entire amount of my paycheck each pay period to be deposited directly into the bank account named above.

_____ Direct payroll deduction deposit.

The undersigned hereby requests and authorizes the sum of ___________________________________________ dollars ($___________ ) be deducted from my paycheck each pay period and to be deposited directly into the bank account named above.

_____ I would like to cancel my deposit authorization.

The undersigned hereby cancels the authorization for direct deposit or payroll deduction deposited previously submitted.

____________________________________ ______________

Employee Signature Date

(Please attach a copy of deposit slip.)