Direct Deposit Employee Authorization Form EVERY FIELD MUST BE COMPLETED, ANY MISSING INFO WILL DELAY THE PROCESS FOR DIRECT DEPOSIT ACTIVATIONLOCATION/SITE(Required)I authorize the Adult Reading Center (hereafter referred to as “Organization”) to direct deposit funds to my account with the financial institution listed below. If funds to which I am not entitled are deposited in my account, I authorize the initiation of a correction (debit) entry electronically or by any other commercially accepted method. I understand that the authorization may be rejected or discontinued at any time. If any of the below information changes, I will promptly complete a new authorization agreement. If the direct deposit is not stopped before closing an account, funds payable to you will be returned to you for distribution. This will delay your check.Check one of the following:(Required)(Required) Start Stop Changing Account Adding An Account Effective Date:(Required) As Soon As Possible Future Pay date: Date MM slash DD slash YYYY Account # – (Type of Account: please check one)(Required) Checking (voided check only, deposits slip are not accepted) Savings (deposit slip only) Financial Institution Name (NAME OF BANK)(Required)City:State :Zip:Phone :ABA Bank Routing Number (must be 9 numbers)(Required)Account Number (not to exceed 17 numbers)(Required)(Enter the above information from the bottom of your check or savings deposit slip, do not include the check number)This authorization will be in effect until the “Organization” receives a written termination notice from the employee below:Employee Signature(Required)Date(Required) MM slash DD slash YYYY Print First, Middle Initial and Last Name(Required)Home Phone Number(Required)I (the “Employee”) understand that by submitting this form means my entire payroll check will be deposited into the above institution. The above “Employee” is required to sign this form to active direct deposit of their paychecks. The “Organization” is to retain this document on file.PhoneThis field is for validation purposes and should be left unchanged.
