HTML Preview Employee Direct Deposit Form page number 1.
Save Time with Direct Deposit
It’s safe, simple and it saves time.
Employer Direct Deposit Sign-Up Form
Take this completed form to your employer’s payroll department to request direct deposit of your payroll check.
Customer Name
Why Direct Deposit?
It’s convenient and it saves time.
• Your check’s automatically
deposited into your account.
• It eliminates a trip to the bank.
• Your money is available in your
account on payday.
It’s safe and secure.
• No more lost or misplaced checks.
• Confirm your deposit by phone or
online.
Address
City State Zip Code
Please have my payroll check automatically deposited into the
following account:
Checking Account Number
or
• You’ll receive a paper voucher for
your records.
It’s simple... here’s how.
• Payroll Checks
Take this completed application
form to your employer’s payroll
department. Include a voided check
so your employer can confirm your
account and routing/transmit
numbers. And that’s it! Your
employer does the rest!
• Government Checks
Your Banker can sign you up today!
Savings/MIA/Money Market Account Number
Bank’s Routing Number
I authorize (name of business)
and my bank to automatically deposit my payroll check into my
account listed above (this includes my authorization to correct
entries made in error.) This authorization will remain in effect until
I give written notice to cancel it.
Customer Signature Date
Member FDIC ©2015 JPMorgan Chase & Co.