Direct Deposit Agreement Form

Direct Deposit Agreement Form
Authorization Agreement
I hereby authorize Autopaychecks, Inc. to initiate automatic deposits to my account at the financial
institution named below. I also authorize Autopaychecks, Inc. to make withdrawals from this account in
the event that a credit entry is made in error, only in the amount of the error.
Further, I agree not to hold Autopaychecks, Inc. responsible for any delay or loss of funds due to incorrect
or incomplete information supplied by me or by my financial institution or due to an error on the part of my
financial institution in depositing funds to my account.
This agreement will remain in effect until Autopaychecks, Inc. receives a written notice of cancellation
from me or my financial institution, or until I submit a new direct deposit form to the Payroll Department.
Employee Information
Division Name:
Div #:
Dept #:
Employee Name:
Account Information
Name of Financial
Institution:
Routing Number:
Account Number:
CHECKING
SAVINGS
CHECKING
SAVINGS
$OR%
Name of Financial
Institution:
Routing Number:
Account Number:
$OR%
Signature
Authorized Signature (Primary): _________________________________ Date: ____________________
Authorized Signature (Joint): ___________________________________ Date: ____________________
Please attach a voided check and return this form to the Payroll Department.
*We are not able to direct deposit into investment accounts.
** Credit Union Account Numbers may be different than actually printed on checks; please verify account numbers with your Credit Union.
***DIRECT DEPOSIT WILL TAKE PLACE APPROXIMATELY 10 BANKING DAYS FROM YOUR NEXT PAYROLL CHECK DATE.
S:\AutoPaychex Documents\Client Original Set-up Forms\John's Sales Files\John's Sales Packets\EE Direct Deposit Agreement Form-NEW.doc