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Wire Transfer Forms

Save time and paper by using the form found below and deposit your paycheck directly into your checking or savings account.







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Electronic Funds Transfer Form

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I authorize my Employer to directly deposit my paycheck into the bank account or accounts listed below and in the percentages as specified. Designated deposits to more than one account shall be made in whole percentages and equal 100%. A voided check or deposit slip has been attached to this form for each account that is listed below. This authorization is to remain in effect until the company receives written authorization from me that it is terminated or changed. I also grant my Employer the right to correct any Electronic Funds Transfer overpayment and give the Employer the ability to deduct any excess funds from the accounts listed below that do not rightfully belong to me.

Name: _______________________________________________________________

Address:______________________City:________________State:_____Zip:_______

Telephone: (______)_________________

Employee Signature:____________________________ Date: _____/_____/_______

Account #1) Checking [___] or Savings [___]

Financial Institution: ____________________________________________________

Address:_____________________City:________________State:_____Zip:________

Telephone: (______)__________________

Percent of pay check to be deposited into Account #1):_____%

Bank Account # _____________________ ABA Routing #______________________

Account #2) Checking [___] or Savings [___]

Financial Institution: _____________________________________________________

Address:______________________City:________________State:_____Zip:________

Telephone: (______)__________________

Percent of pay check to be deposited into Account #2):_____%

Bank Account # _____________________ ABA Routing #_______________________

Company Use Only:

Effective Date: Date: _____/_____/_______









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