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Direct Deposit Authorization Attach A Voided Check

This document is an authorization form for employees to set up direct deposit for their paychecks into specified bank accounts. Employees must provide their bank account details, including routing numbers, and attach a voided check for verification. The authorization remains effective until a written termination notice is provided to the company.

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hmulan991
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34 views1 page

Direct Deposit Authorization Attach A Voided Check

This document is an authorization form for employees to set up direct deposit for their paychecks into specified bank accounts. Employees must provide their bank account details, including routing numbers, and attach a voided check for verification. The authorization remains effective until a written termination notice is provided to the company.

Uploaded by

hmulan991
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Authorization for Direct Deposit - Employee Form

Kate Colby Nelson


This authorizes ______________________________________________________________________________ (the “Company”)
to send credit entries (and appropriate debit and adjustment entries), electronically or by any other commercially accepted method, to
my (our) account(s) indicated below and to other accounts I (we) identify in the future (the “Account”). This authorizes the financial
institution holding the Account to post all such entries.

Note: Enter your company name in the blank space above.

Account #1
Account #1 Type (check one): ☐ Checking ☐ Savings
Walmart Money Card
____________________________________________________
Employee Bank Name
124 303 120 111872765643
____________________________________________________ ____________________________________________________
Bank Routing # (ABA#) Account #
Deposit my entire paycheck
________________________________________________
Percentage or Dollar Amount to be Deposited to This Account

Account #2 (remainder to be deposited to this account)


Account #2 Type (check one): ☐ Checking ☐ Savings
Walmart Money Card
____________________________________________________
Employee Bank Name
124 303 120 111872765643
____________________________________________________ ____________________________________________________
Bank Routing # (ABA#) Account #

Please attach a voided check for each account here.

This authorization will be in effect until the Company receives a written termination notice from myself and has a reasonable
opportunity to act on it.

____________________________________________________
Signature
Katenelson
____________________________________________________
Printed Name
06/03/2025
____________________________________________________ ____________________________________________________
Employee ID # Date

IMPORTANT: This document must be signed by employees requesting automatic deposit of paychecks and retained on file
by the employer. Do not send this form to Intuit. Employees must attach a voided check for each of their accounts to help
verify their account numbers and bank routing numbers.

Employee: Please fill out and return to your employer. Employer: Please save for your files only.

eForms.com Ver. 041708 DD

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