DIRECT DEPOSIT FORM
This is an authorization agreement for automatic deposits (ACH Credits).
I authorize the above named Company/Employer and the financial institution listed
below to electronically deposit my net pay to the specified account each payday:
If monies to which I am not entitled are deposited to my account, I authorize my
Company/Employer to direct the financial institution to return said funds.
This authority will remain in effect until I have filed a new authorization, or until revoked
by me in writing or upon termination of my employment with said Company/Employer.
Social Security Number
Staple, in this box, a VOIDED check or deposit ticket for the account indicated above.
Return this completed form to your Company/Employer.
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