South Carolina Direct Deposit Form 3

Employee Direct Deposit
Payee Authorization Form
SC(6)
PAYROLL MANAGER:
Please complete this section and send a copy to your CompuPay office or fax this form to your CompuPay Specialist
Account #
Company Name
(Please print)
Date
To enroll in Full Service Direct Deposit, simply fill out this form and give it to your payroll manager. Attach a voided check for each checking
account - not a deposit slip. If depositing into a savings account, 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.
Important! Please read and sign before completing and submitting.
I hereby authorize CompuPay to deposit any amounts owed me as instructed by my employer by initiating credit entries to my accounts at the financial institutions
(hereinafter “Bank”) indicated on this form. Further, I authorize Bank to accept and to credit any credit entries indicated by CompuPay to my accounts. In the
event that CompuPay deposits funds erroneously into my account, I authorize CompuPay to debit my account for an amount not to exceed the original amount of
the erroneous credit account. I further authorize CompuPay to debit my account in the event my employer does not provide funds to cover credits initiated by
CompuPay.
This authorization is to remain in full force and effect until CompuPay and Bank have received written notice from me of its termination in such time and in
such manner as to afford CompuPay and Bank reasonable opportunity to act on it.
Employee Name:
Social Security #:
Employee Signature:
Date:
Account Information
Make sure to indicate what kind of account, along with the amount to be deposited if less than your total net paycheck.
Account Type
Bank Name
A
C
Checking
Savings
C
T
Account #
Amount to deposit
Routing/Transfer #
$
1
A
C
C
T
Checking
Routing/Transfer #
Account #
$
or
Other
Balance of Net
Account Type
Bank Name
Checking
Routing/Transfer #
Account #
Amount to deposit
$
Savings
or
Other
Balance of Net
Account Type
Bank Name
Checking
Routing/Transfer #
Account #
Amount to deposit
$
4
A
C
C
T
Savings
Amount to deposit
3
A
C
C
T
Balance of Net
Account Type
Bank Name
2
A
C
C
T
or
Other
Savings
or
Other
Balance of Net
Account Type
Bank Name
Checking
Routing/Transfer #
Account #
Amount to deposit
$
5
Savings
or
Other
Balance of Net
Below is a sample check MICR line, detailing where the information necessary to complete the form can be found.
Memo
: 012345678 :
Routing/Transit #
(A 9-digit number always
between these two marks)
123456789
Checking Account #
0101
Check #
(this number matches the number in
the upper right corner of the check-not needed for sign-up)
ATTENTION PAYROLL MANAGER:
Employers must keep each original employee enrollment form on file as long as the employee is using FSDD, and for two years thereafter.
Version 0307
SC(6) page 1