Here’s a basic direct deposit authorization form that you can use:
[Company Name]
[Company Address]
[City, State ZIP Code]
[Company Phone Number]
[Employee Name]
[Employee Address]
[City, State ZIP Code]
[Employee Phone Number]
[Employee Email]
Authorization for Direct Deposit
I hereby authorize [Company Name] to initiate credit entries to my account at the financial institution named below and to debit the same to such account. I understand that the financial institution named below is authorized to deposit funds into my account based solely on the information provided on this form.
[Employee Signature]
Financial Institution Information:
[Name of Financial Institution]
[Address]
[City, State ZIP Code]
[Financial Institution Phone Number]
[Routing Number]
[Account Number]
I certify that the above information is correct and accurate. By signing below, I authorize [Company Name] to deposit my pay directly into the account specified.
[Employee Signature]
[Date]