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Clients forms




The direct deposit form allows employees to receive their payroll or workers compensation payments securely and efficiently.

Personal Information

Financial Institution Information

REQUIREMENTS: Please attach one of the following for each direct deposit that must be in your name.

For a Checking* Account: a copy of a voided check for each bank account to which funds should be deposited. Check must contain preprinted name and address information.

For a Savings** Account: a bank verification letter stating: your name, routing number, and account number.

Funds transferred by electronic transmission normally post to an account in two to three business days after the payroll is processed. Leased employee remains responsible for verifying that the funds are deposited, clear, and available prior to writing checks or debiting account.

I hereby authorize and grant my employer the right to initiate credit entries to my account with the financial institution named above, and to correct any electronic funds transfer, resulting from an erroneous overpayment, by debiting my account to the extent of such overpayment. In the event this Direct Deposit Authorization form is incomplete or contains incorrect information, I understand a check will be issued to my address of record.

*Any official bank form displaying the company name, routing and account number are also accepted (PDF, JPEG, JPG, PNG)