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Direct Deposit Authorization

Complete the form fields below to generate a Direct Deposit Authorization that you can print and use to authorize all or part of your paycheck being deposited to your bank account.

Click here for a sample. All information appearing in bold type are the form fields that are either automatically completed by the program or completed based on information you supplied in this form.

Company:
Address:
City:
State/Province:	(Select a state for U.S. clients or a Canadian province)
Zip/Postal Code:
Country:
Phone:
Employee's Name:
Employee I.D.#:	(Enter the employee I.D. number, if applicable)
Employee's S.S.#	Enter employee's social security number)
Bank Name:
Branch:	(Enter branch name and/or number, if applicable)
Bank Address:
City:
State/Province:	(Select a state for U.S. clients or a Canadian province)
Zip/Postal Code:
Country:
Account Number:	(Your checking or savings account number)
Select one below: Direct deposit. I hereby authorize and request that the full amount of my paycheck be deposited directly into the above-named bank account. Direct payroll deduction deposit I hereby authorize and request that the sum of $ be deducted from my paycheck each pay period and to be deposited directly into the above-named bank account. Please cancel my direct deposit authorization: I hereby cancel my authorization for direct deposit of my payroll wages.

This is not a substitute for legal advice and it is suggested that an attorney be consulted.

Direct Deposit Authorization

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