Employee Direct Deposit Enrollment Form printable pdf download

Employee Direct Deposit Enrollment Form

Tri-County ARC

Employee Direct Deposit Enrollment Form

To enroll in Full Service Direct Deposit, simply fill out this form and return it to the payroll

office. Attach a voided check for each checking account – not a deposit slip. If depositing to a

savings account, ask your bank to give you the Routing/Transit number for your account. (It

isn’t always the same as the number on a savings deposit slip). This will help ensure that you

are paid correctly.

The 9-digit routing/transit number is located at the bottom left had side. The account number

is usually in the lower center of the check.

Employee Name: ____________________________ Employee I.D. # _________

Employee Signature: ___________________________ Date: _______________

Account Information:

The last item must be for the remaining amount owed to you.

Make sure to indicate what kind of account, along with the amount to be deposited, if less than

your total net paycheck.

Bank Name: ______________________________________________________

Routing Transit #: ____________________ Account #: ____________________

Checking ___ Savings ___ Other ___

I wish to deposit: $_________ or Entire Net Amount ____

Bank Name: ______________________________________________________

Routing Transit #: ____________________ Account #: ____________________

Checking ___ Savings ___ Other ___

I wish to deposit: $_________ or Entire Net Amount ____

Bank Name: ______________________________________________________

Routing Transit #: ____________________ Account #: ____________________

Checking ___ Savings ___ Other ___

I wish to deposit: $_________ or Entire Net Amount ____

Employee Direct Deposit Enrollment Form