EMPLOYEE DIRECT DEPOSIT BANKING AUTHORIZATION FORM
Important! Please read and sign before completing and submitting.
I hereby voluntarily authorize the Company named above (hereafter “Employer”), either directly or through its payroll service
provider, to deposit any amounts owed me, by initiating credit entries to my account (s) at the financial institution (s) of my
choice (hereinafter “Bank”) indicated on this form. Further, I authorize Bank to accept and to credit any credit entries indicated
by Employer, either directly or through its payroll service provider, to my account. To the extent permitted by law, in the event
that Employer or its payroll service provider deposits funds erroneously into my account (s), I authorize Employer, either
directly or through its payroll service provider, to debit my account for an amount not to exceed the original amount of the
To the extent permitted by law, I understand that I have the right to refuse consent or revoke authorization of direct deposit at
any time without fear of retaliation, and I have the right to receive any payment owed to me by other means. This
authorization is to remain in full force and effect until Employer and Bank have received written notice from me of its
termination in such time and manner as to afford Employer and Bank reasonable opportunity to act on it.