Direct Deposit Authorization {HR-703}

DIRECT DEPOSIT AUTHORIZATION Full Legal Name: Identification Number: Social Security Number: Bank Name/Branch: Account Number: Check the appropriate item: Direct deposit. The undersigned hereby requests and authorizes the entire amount of my paycheck each pay period to be deposited directly into the bank account named above. Direct payroll deduction deposit. The undersigned hereby requests and authorizes the sum of dollars [$amount] be deducted from my paycheck each pay period and to be deposited directly into the bank account named above. I would like to cancel my deposit authorization. The undersigned hereby cancels the authorization for direct deposit or payroll deduction deposited previously submitted. Employee Signature Date (Please attach a copy of deposit slip.) American LegalNet, Inc. © www.FormsWorkFlow.com