Direct deposit authorization form

The standard form employers ask for to pay you by direct deposit: your bank details, the account split you want, and your authorization. Attach a voided check if your employer requests one.

Fill in what you know. Anything left blank stays a fillable field in the PDF, so you can finish it later in any PDF reader.

1. Employee

Full name *

Employee ID (if any)

Employer / company

2. Primary account

Bank name

Routing number (9 digits)

Account number

Checking

Savings

Deposit amount or percentage (or "remainder")

3. Second account (optional)

Use this section to split your pay across two accounts.

Bank name

Routing number (9 digits)

Account number

Checking

Savings

Deposit amount or percentage

4. Authorization

I authorize my employer to deposit my pay to the account(s) above and, if funds are deposited in error, to withdraw the erroneous credit. This authorization stays in effect until I replace or cancel it in writing, and I understand a change may take one or two pay cycles to apply.

Date

Employee signature

Notice

This document is a general-purpose template provided for convenience. It is not legal advice, and no attorney-client relationship is created by using it. Execution requirements such as witnesses and notarization vary by state. For significant assets or complex situations, have a lawyer review the final document.

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Direct deposit authorization form

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