Sodexo Direct Deposit – Fill Out and Use

ADP Sodexo Payroll Service Center P.O. Box 17033

Augusta GA 30903 925-598-9558

Direct Deposit/Pay Card Authorization Form (Add, Change, Delete)

Instructions: This form is completed to add a new, change or delete a Direct Deposit or Pay Card account. To ensure prompt processing, provide all required information. All fields with the (◄) symbol indicate information is required for processing. To modify more than three direct deposit or pay card accounts, use multiple forms as needed.

Note: Employees may have their net pay allocated and deposited into more than one bank account. New accounts must go through a “pre- notification process” (your bank account information must be validated with the bank before direct deposit can begin) , which will take up to two pay cycles. If you are currently receiving a Live Check, you will continue to do so until your request has been successfully processed. Keep this form until you have verified that your request has been processed.

Section 1: Employee Information

First Name ◄	Middle Initial	Last Name ◄	Suffix

Note: "Employee ID" is a required field. If your "Employee ID" is not displayed on your Pay Statement (in the "Miscellaneous" section), you must provide your "Company Code (Paygroup)" AND "Employee File Number" (from the top left corner of your Pay Statement). If you do not have an "Employee ID" or "Employee File Number" please include your "Date of Hire".

By signing below, I authorize the above-named company and/or its representative to initiate direct deposit (credit) entries. If funds to which I am not entitled are deposited to my account, I authorize ADP COS and/or its representatives to direct the bank to return said funds (debit). I understand that my bank must be a member of the “Automated Clearing House (ACH)” in order for my net pay to be processed via Electronic Funds Transfer (EFT). I understand I will be notified if there is a problem with my ACH account transaction during pre-note as stated above. This authorization is to remain in effect until it is changed or canceled by me via the Direct Deposit/Pay Card Authorization Form or my employment terminates (Client reserves the right to cancel Direct Deposit on termination). I understand that I must allow sufficient time as noted above for the processing of such changes or cancellation.

Employee Signature:

Signature ◄		Date of Request ◄
Contact Email Address ◄		Contact Telephone Number ◄

Section 2: Account Details

For a bank account, use reference below to locate your Bank Account Number and Bank Transit Routing Number. If you only have one (1) account in the direct deposit program, the entire amount of the Net Pay will be deposited into that account if you select Balance. If you select a set amount, the balance will be issued in a live check. If you specify two (2) or three (3) accounts, a portion of your Net Pay will be deposited into the other account(s) that is/are designated as dollars ($). Any remaining net pay will then be deposited into the account designated as balance or issued in a live check.

For a pay card, please review the documentation received with your pay card to provide the Bank Transit Routing Number, Bank Account Number, and Account Type (usually checking). If you do not have this information or have any questions about it, please contact your card’s issuer. Do not provide the number from the front of the pay card, which is valid only for purchases.

Account One (1) Details -- Check One◄:			New	Change	Cancel
	Enter Bank Transit Routing Number (series of nine (9) numbers,
				NOT starting with a "5") ◄:
			Enter Bank Account Number◄:
Select Account				Amount of Net Pay		Balance
Type◄:			(indicate amount OR check "Balance")◄:
Account Two (2) Details -- Check One:			New	Change	Cancel
	Enter Bank Transit Routing Number (series of nine (9) numbers,
				NOT starting with a "5") :
			Enter Bank Account Number:
Select Account				Amount of Net Pay		Balance
Type:			(indicate amount OR check "Balance"):
Account Three (3) Details -- Check One:			New	Change	Cancel

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Copyright (c) 2011 ADP Comprehensive Outsourcing Services. All rights reserved.	12/2012