Here’s a basic direct deposit form template that you can use:
[Company Name]
[Company Address]
[City, State ZIP Code]
[Company Phone Number]
[Company Email]
Direct Deposit Form
[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: [Enter Name of Financial Institution]
- Address: [Enter Address]
- City, State ZIP Code: [Enter City, State ZIP Code]
- Financial Institution Phone Number: [Enter Financial Institution Phone Number]
- Routing Number: [Enter Routing Number]
- Account Number: [Enter Account Number]
- Account Type: [Enter Account Type, such as checking or savings]
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]