Employee Direct Deposit Enrollment Form

Employee Direct Deposit Enrollment Form Payroll Manager- Please complete this section and send n copy to ADP for mroilment(P lease print) Company Code: Company Name: Employee File Number: Payroll Mgr. Name: Payroll Mgr. Signature: To enroll m Full Service Direct Deposit, simply nil out this form and give to yew payroll manager. Attach a voided check for each checking account • not a deposit slip. If depositing to a savings account, ask your tank 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. Below is a sample check MICR line, detailing where the information mammy to complete this Cam con be found. • • Routingillaasit (A 9-digit nut slaws between these two aka) Checking Aceount Check (this number matches the number in the upper right comer of the check - not needed for sign-up) IMPORTANT! Please read and sign before completing and submitting. hereby authorize ADP to deposit any amounts owed me, as instructed by my employer, by initiating credit entries to my account at the financial institution (hereinafter - Bank') indicated on this form, Further, I authorize Batik to accept and to credit any credit entries indicated by ADP to my account. In the even that ADP deposits funds erroneously into my Moots* I authorize ADP to debit my account for an amount not to exceed the original amount of the erroneous credit This authenration is to remain in full force and effect until ADP and Bank have received written notice from me of its termination in such time and in such marmer as to afford ADP and Bank reasonable opportunity to act on it. Employee Name: Social Security 4: - - Employee Signature: Date: Account Information The last item must be for the remaining amount owed to you. To distribute to more accounts, please complete another form. Make sure to indicate what kind of account, along with amount to be deposited, if less than your total net paycheck. I. Bank Name/CIty/State: Routing Transit N: Account Number: O Chocking DSavings O Other I wish to deposit: S or O Entire Net Amount 2. Bank Name/City/State: Routing Transit N: Account Number: OChecking O Savings O Otter I wish to deposit S or K Entire Net Amount 3. Bank Ntune/City/State: Routing Transit Account Number: O Checking O Savings O Other I wish to deposit $ or O Entire Net Amount ATTENTION PAYROLL MANAGER: Employers most keep each original employee enrollment form on file as long as the employee is using FSDD, and for two years thereafter. ADP is a registered trade:nut of ADP of North America lac. Full Service Direct Deposit (FSDD) is a service rook of AI:OM-Olt DMA Aonning, tat 02-114419 SOYA Primed In USA 01999. I991 Automate Data Procesung• Inc. EFTA00301311