Here’s a basic direct deposit form that you can use:
[Bank Name]
[Bank Address]
[City, State ZIP Code]
[Bank Phone Number]
[Bank Email]
Direct Deposit Authorization Form
Employee Information:
- Full Name: [Enter Full Name]
- Address: [Enter Address]
- City, State ZIP Code: [Enter City, State ZIP Code]
- Phone Number: [Enter Phone Number]
- Email: [Enter Email]
- Social Security Number: [Enter Social Security Number]
- Date of Birth: [Enter Date of Birth]
Bank Information:
- Bank Name: [Enter Bank Name]
- Bank Routing Number: [Enter Bank Routing Number]
- Bank Account Number: [Enter Bank Account Number]
- Account Type: [Enter Account Type, such as Checking or Savings]
Authorization Agreement:
I authorize my employer, [Employer Name], to initiate credit entries to my account at [Bank Name] for the purpose of direct deposit. I understand that I am responsible for verifying that the credit has been made to my account.
I understand that I must notify my employer promptly if there are any changes to my bank account information, including changes to my account number or account type.
I certify that the above information is correct and accurate. By signing below, I authorize [Employer Name] to initiate direct deposit to my bank account.
[Employee Signature]
[Date]