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Run: Direct Deposit Authorization Form

A Direct Deposit Authorization Form for collecting employee bank details, split deposit instructions, and signed authorization in one place. Use it to set up...

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Employee Information

Full Name (required)

Employee ID (required)

Work Email (required)

Department

Bank Account Details

Account Holder Name (required)

Bank Name (required)

Account Type (required)

Routing Number (required)

Account Number (last 4 digits) (required)

For security and data minimization, enter only the last 4 digits of the account number.

Deposit Type (required)

Split Deposit Instructions

How should the deposit be split? (required)

Split Percentage

Enter the percentage of each paycheck to deposit into this account.

Split Amount

Enter the fixed amount to deposit into this account each pay period.

Where should the remaining balance go? (required)

Verification and Authorization

Verification Document

Optional: upload a voided check or bank letter if your payroll team requires verification.

I authorize my employer to deposit my net pay into the bank account(s) provided above and, if necessary, to reverse any erroneous deposits made in error. (required)

Yes No N/A

I consent to the collection and processing of my PII and banking information for payroll administration and verification purposes. (required)

Yes No N/A

Electronic Signature (required)

Date (required)

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Email (required)

Your name (optional)

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