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Employee Direct Deposit Form

This form is used by employees of Staff N Go, LLC DBA Strategies Staffing to set up, change, or cancel direct deposit for paycheck deposits. It collects the employee's name, address, phone number, social security number, financial institution details like bank name and routing number. The employee authorizes Staff N Go to deposit payments electronically and acknowledges they may reverse any payments made in error in accordance with NACHA rules.

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huma mirza
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371 views3 pages

Employee Direct Deposit Form

This form is used by employees of Staff N Go, LLC DBA Strategies Staffing to set up, change, or cancel direct deposit for paycheck deposits. It collects the employee's name, address, phone number, social security number, financial institution details like bank name and routing number. The employee authorizes Staff N Go to deposit payments electronically and acknowledges they may reverse any payments made in error in accordance with NACHA rules.

Uploaded by

huma mirza
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Employee Direct Deposit Authorization

This form may be used by employees


- To receive payments from Staff N, Go, LLC DBA Strategies Staffing
- To change or cancel existing direct deposit information
☐ New Setup (Section 2, 3 and 4)
SECTION 1

☐ Change (Section 2, 3 and 4)


☐ Cancellation (Section 2, 3 and 4)

Transaction Type

Employee Identification
Social Security Number (SSN) Mail code
(if not known, leave blank)
SECTION 2

Payee Name Phone number ext.


( )
Mailing Address City State Zip code

Financial Institution (Completion by financial institution is recommended)


Financial institution name City State

Routing transit number (9 digits) Customer account number Type of account


SECTION 3

Financial representative name (optional) Title (optional)

Financial representative signature (optional) Phone number (optional) Date (optional)


( ) ext.

Authorization for Setup, Changes or Cancellation (required)


SECTION 4

I authorize Staff N Go LLC DBA Strategies Staffing to deposit my payments to my financial institution
electronically. I understand that Staff N Go, LLC DBA Strategies Staffing will reverse any payments
made to my account in error.
I further understand that the Staff N Go LLC DBA Strategies Staffing will comply at all ties with the
National Automated Clearing House Association’s rules. (For further information on these rules,
please contact your financial institution.)
Authorized signature Printed name Date

Sign here →

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