Direct Deposit Authorization Form

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Direct Deposit Authorization Form

A direct deposit authorization form is a document that enables an employer to transfer money directly into the bank account of an employee on their payroll. It can also be used by independent contractors to collect payments from their clients. The form requires the payee’s account info, a statement of consent, and their signature.

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Last updated May 12th, 2025

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A direct deposit authorization form is a document that enables an employer to transfer money directly into the bank account of an employee on their payroll. It can also be used by independent contractors to collect payments from their clients. The form requires the payee’s account info, a statement of consent, and their signature.

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DIRECT DEPOSIT AUTHORIZATION

Name: [PAYEE NAME]     Address: [PAYEE ADDRESS]

Name of Bank: [NAME OF BANK] 
Account #: [ACCOUNT NUMBER] 
9-Digit Routing #: [ROUTING NUMBER]

Amount: ☐ $ [DOLLAR AMOUNT]    ☐ [PERCENTAGE] % or  ☐ Entire Amount
Type of Account:   ☐ Checking      ☐ Savings

Attach a voided check for each bank account to which funds should be deposited (if necessary).

[PAYOR NAME] is hereby authorized to directly deposit my pay to the account listed above. This authorization will remain in effect until I modify or cancel it in writing.

Payee Signature: ______________________    Date: [MM/DD/YYYY]