Direct Deposit Authorization Form

for Your State

This Direct Deposit Authorization Form is used when depositing an employee's paycheck via direct deposit. This form contains all necessary information including account and routing numbers and employee's signature authorizing the direct deposit.

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This Direct Deposit Authorization Form is used when an employee wants their checks to be deposited directly with their bank. This form includes an authorization for direct deposit, account information, (including routing and account number) and the authorized signature of the employee. It also allows the employee to deposit funds in either a checking or savings account. This Direct Deposit Authorization Form can easily be tailored to fit your company's needs.

This Direct Deposit Authorization Form includes:
  • Authorization Agreement: Agreement which authorizes your company to direct deposit an employee's paycheck;
  • Employee Information: Name of financial institution, routing number, account number and signature of the employee which authorizes the direct deposit.

Protect your rights and your company by using our attorney-prepared forms.

This attorney-prepared packet contains:
  1. General Instructions
  2. Direct Deposit Authorization Form
State Law Compliance: This form complies with the laws of all states
Number of Pages3
DimensionsDesigned for Letter Size (8.5" x 11")
EditableYes (.doc, .wpd and .rtf)
UsageUnlimited number of prints
Product number#32690
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.












Direct Deposit Authorization Form










This Packet Includes:
1. General Instructions & Checklist
2. Direct Deposit Authorization Form









General Instructions & Checklist
 Direct Deposit Authorization Form


   This is a Direct Deposit Authorization Form. It is used to get authorization from employees of a company to directly deposits monies into the employees bank account, i.e. paychecks etc.

   You can replace the larger “Your Company Name” with the name of your own company. If you have a logo, you can replace the “Your Logo Goes Here” placeholder graphic with your own logo. Otherwise, you can also simply delete the placeholder graphic.

   Bracketed instructions may be included on this form to assist you in completing it and should be removed before printing. Generally in Microsoft Word, you can click on the bracketed instruction and start typing.

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Direct Deposit Authorization Form

Authorization Agreement
I hereby authorize [Company Name] to initiate automatic deposits to my account at the financial institution named below. I further authorize [Company Name] to make withdrawals from this account in the event that a credit entry is made in error.
I agree not to hold [Company Name] 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 [Company Name] 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.
Account Information
Name of Financial Institution:

Routing Number:

The first 9 numbers from the left at the bottom of your check are your Bank Routing Number. This number is always 9 digits.
Account Number:



Checking

Savings


Signature
Authorized Signature (Primary):



Date:

Authorized Signature (Joint):



Date:




Please attach a voided check or deposit slip and return this form to the Payroll/HR Department.

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