Direct Deposit Authorization Form - Free, Word & PDF

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Employee Name		Employee ID		Employer
Department		Phone		Email

This Request Is To	Start direct depositChange accountAdd an accountStop direct deposit

Bank Name		Account Type	CheckingSavings
Routing Number		Account Number
Deposit	Entire net payFixed amount $____Percent ____%Remainder of net pay

Bank Name		Account Type	CheckingSavings
Routing Number		Account Number
Deposit	Entire net payFixed amount $____Percent ____%Remainder of net pay

Attached	Voided checkBank direct deposit letter

Received By		Date Entered		Effective Date		Prenote Sent

How to fill out a Direct Deposit Authorization Form

Direct Deposit Authorization Form template preview — Free Direct Deposit Authorization Form template

A direct deposit authorization form gives an employer permission to deposit an employee’s pay into one or more bank accounts. It records the bank, routing and account numbers, account type and how pay should be split, and is signed by the employee.

How to fill it out

Fill in the employee’s name, ID, employer, department and contact details.
Choose whether you are starting, changing, adding or stopping direct deposit.
Enter the bank name, account type, routing and account number for each account.
Choose how much goes to each account — all, a fixed amount, a percent or the remainder.
Attach a voided check or bank letter, sign and return the form to payroll.

Tips

Copy routing and account numbers from a check or your bank — a single wrong digit sends pay to the wrong place.
Keep a paper check for the first pay period in case the deposit takes a cycle to start.
Employers should store completed forms securely and limit access.
This is a payroll form, not a bank form.

Direct Deposit Authorization Form example

Employee Information

Employee Name: Jane Smith
Employee ID: E-1015
Employer: Acme Supply Co.
Department: Customer Service
Phone: (555) 123-4567
Email: [email protected]

Request Type

This Request Is To: Start direct deposit

Account 1 (Primary)

Bank Name: First Springfield Bank
Account Type: Checking
Deposit: Remainder of net pay

Account 2 (Optional)

Bank Name: Prairie Credit Union
Account Type: Savings
Deposit: Fixed amount $____

Authorization

Attached: Voided check

For Payroll Use

Received By: Maria Lopez
Date Entered: 10/14/2026
Effective Date: 10/30/2026
Prenote Sent: Yes, 10/14

All names, companies and contact details are fictional. Click “Fill sample” above to put this example into the empty fields; click again to remove the parts you did not change.

FAQ

Where do I find my routing number?

At the bottom left of a check (9 digits), in your online banking, or on a direct deposit letter from your bank.

Can I split my paycheck between two accounts?

Yes. Enter a fixed amount or percent for one account and choose “Remainder” for the other.

How long does direct deposit take to start?

Often one or two pay periods, depending on your employer’s payroll provider.

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