Direct deposit is a fast and convenient way to receive your paycheck without having to worry about it getting lost in the mail or stolen from your mailbox. This form allows you to authorize direct deposit of your paychecks, pensions, annuities, etc. into any bank account you choose. Employers should ensure that they securely store direct deposit authorization forms and keep employee banking information confidential. Additionally, employers should establish a process for collecting and updating direct deposit information as needed.
| Question | Answer |
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| Form Name | Direct Deposit Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | blank deposit form, generic direct deposit form, direct deposit authorization form |
DIRECT DEPOSIT AUTHORIZATION FORM
Fill in the boxes below and sign the form.
Last Name
Social Security Number
Action
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Change |
Cancel |
Name of Financial Institution
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First Name |
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M I |
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Work Phone
Effective Date
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Year |
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Account Number
Routing Transit Number
(Include hyphens but omit spaces and special symbols.)
(All 9 boxes must be filled. The first two numbers must be 01 through 12 or 21 through 32.)
Type of Account
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Checking |
Savings |
Ownership of Account
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Joint |
Other |
By signing this agreement, I authorize ____________________ to initiate credit entries to the account indicated above for the purpose of expense and/or payroll.
I also authorize ______________________________ to initiate, if necessary, debit entries and adjustments for any credit entries made in error.
Signature ____________________________________________________________________________________ Date ___________________
If the account is a joint account or in someone else's name, that individual must also agree to the terms stated above by signing below.
Signature ____________________________________________________________________________________ Date ___________________
HOW TO COM PLETE THIS FORM
1.Fill in all boxes above.
2.Sign and date the form.
Call your financial institution to TIP make sure they will accept direct
deposit s.
Verify your account number and TIP routing transit number with your
financial institution
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TIP |
Do not use a deposit slip to verify |
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the routing number. |
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Routing Transit Number
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Account |
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Number |
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JOHN PUBLIC |
1234 |
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123 MAIN STREET |
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19 |
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YOUR TOWN, FL 12345 |
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PAY TO THE |
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ORDER OF |
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YOUR TOWN BANK |
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DOLLARS |
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YOUR TOWN, FL 12345 |
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FOR |
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250000005 |
1234556789022 |
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➤ |
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NOTE: THE ACCOUNT AND ROUTING NUM BER M AY APPEAR IN DIFFERENT PLACES ON YOUR CHECK.