Tax Identification Number: ________
Asa matter of convenience to our employees, the [Company] can direct deposit either a portion of or your entire payroll to the financial institution of your choice.
[ ] Please Direct Deposit my entire net payroll check to:
Name of Bank and Branch:_________________
I, [state full name] do hereby request the deposit of my entire net payroll check into the above named bank account each pay period. I further authorise ______________ and ___________ to withdraw any funds deposited in error into my account.
[ ] Please deposit a portion of my payroll through a Direct Payroll Deduction to:
I hereby request and authorise the sum of __________ to be deducted from my paycheck each pay period, and to be deposited directly into the bank account named above. I further authorise ________ and ________ to withdraw any funds deposited in error into my account.
[ ] I would like to cancel my deposit authorisation. I hereby cancel the previously submitted authorisation for direct deposit and/or payroll deduction deposit .
Employee Signature ________________________
copy of deposit slip attached.