Employee Direct Deposit / Bank Account Initiation Form

 

 

 

 

Employee Name (Please Print) ___________________________________

 

Social Security Number:  _______________________________________

 

 

 

 

   I would like my wages/salary deposited into the following bank account:

 

   Bank Account # 1     ____  Checking     or   ____  Savings

 

 

   I wish to deposit (check one):

 

   ____       Entire Net Pay

 

   ____       ___% of Net

 

   ____       Specific Dollar Amount $ ______

 

 

 

 

   Please attach one of the following:

 

   ____        Voided Check

 

   ____         Bank Letter of Specification Sheet*

                   *See your local bank representative