DIRECT DEPOSIT FORM Employee Name * First Name Last Name Social Security Number I hereby authorize Time & Payroll and the financial institution(s) listed below to initiate credit entries or adjusting entries (either credit or debit, which are necessary for corrections) to the indicated account(s) below. I understand that I will not write checks or otherwise debit my account before first making certain that sufficient funds are available, and that neither my employer nor Time & Payroll shall be liable for such overdrafts due to delay of funds posting. Bank 1 Name Bank Routing Number Bank Account Number Bank Account Type Checking Savings Amount Bank 2 Name Bank 2 Account Type Checking Savings Bank 2 Routing Number Bank 2 Account Number Amount Bank 3 Name Bank 3 Account Type Checking Savings Bank 3 Routing Number Bank 3 Account Number Amount This authority is to remain in full force and effect until company has received written notification from me (or either of us) of its termination in such time and in such manner as to afford a reasonable opportunity to act on it. PLEASE CHECK ONE New or Additional Direct Deposit: Change the Bank or Account Number Change the Amount Other A VOIDED CHECK MUST BE ATTACHED TO THIS FORM FOR EACH ACCOUNT AS VERIFICATION. DO NOT USE A DEPOSIT SLIP. Signature Date MM DD YYYY Thank you!
