Lunar Massage Employee Direct Deposit Form

Employee Direct Deposit Form

Please fill out Employee - Required Information, direct deposit information, and sign form, then return to your Employer along with the required documentation. Certain accounts may have restrictions on deposits and withdrawals. Check with your bank for more information specific to your account.

Employee Information

Name *

First

Last

Employee Number/Dept *

New/Additional Account
Change Account
Change in Amount
Other (please explain)

Other (please explain) *

I would like my wages/salary deposited to the following bank account(s):

Bank/Routing Number *

Account Number *

Checking / Saving *

Checking
Savings

Amount *

Would you like to add an additional bank account? *

Yes
No

Bank/Routing Number *

Account Number *

Checking / Saving *

Checking
Savings

Amount *

Would you like to add an additional bank account? *

Yes
No

Bank/Routing Number *

Account Number *

Checking / Saving *

Checking
Savings

Amount *

Would you like to add an additional bank account? *

Yes
No

Bank/Routing Number *

Account Number *

Checking / Saving *

Checking
Savings

Amount *

Voided Check, deposit slip, or bank letter is required for each account We are unable to accept temporary or starter checks and deposit slips are only accepted if the verbiage 'ACH R/T' appears before the routing number.) Bank letter or specification sheet (signed by a Bank Representative) for all other accounts * *See your local bank representative.

Please note: It is the employee's responsibility to verify deposits on a per pay period basis before writing checks against these funds. This authorization can take up to three (3) pay periods to activate. Neither your employer nor our payroll processing company is responsible for bank errors or bank fees. You may cancel these Direct Deposit(s) at any time with verbal or written communication, including the use of this form.

Date / Time *

Employee Signature *

By signing above, I am agreeing that l am either the accountholder or have the authority of the accountholder to authorize my employer to make direct deposits into the named account.