DIRECT DEPOSIT FORM – EMPLOYEE AUTHORIZATION
Employer / Company Name:
Employee Name:

Emp #:

I authorize Reichard Staffing and the financial institution(s) listed below to deposit my pay
automatically to the indicated account(s) and to make adjusting entries as may be required.

Bank/Credit Union

ST

Type
(Circle
One)

Amount
or
Percentage

Routing
Number

Account
Number

Checking
Savings
Checking
Savings
Checking
Savings

Please Select One:
New or Additional Direct Deposit
Change the Bank or Account Number
on an Existing Direct Deposit
Change the Amount of an
Existing Direct Deposit
Other, Please Explain:

Account Number
to be replaced:
Amount
Was:

Amount
changed to:

** PLEASE ATTACH A VOIDED CHECK FOR THE DIRECT DEPOSIT BANK ACCOUNT AS
VERIFICATION FOR EACH REQUEST **
It is my responsibility to verify deposits on a per pay period basis before writing checks against these
funds. This Authorization can take up to two pay periods to activate. I understand that neither my
employer nor Reichard Staffing is responsible for bank errors or fees. I may cancel this Direct
Deposit(s) at any time.

Signature: ___________________________________

Date: _______________