Direct Deposit Enrollment Form

To enroll in direct deposit, complete and submit this form.

I hereby authorize My Employer whose name is entered below ("My Employer") and Easytrack Payroll LLC, acting as My Employer’s payroll processing service, to deposit any amounts owed me by initiating credit entries to my accounts at the financial institutions (hereafter “Bank”) indicated on this form.  Further, I authorize Bank to accept and credit any credit entries initiated by My Employer to my accounts.  In the event that My Employer deposits funds erroneously into my account, I authorize My Employer to debit my account for an amount not to exceed the original amount of the erroneous credit.

 

Furthermore, I accept receiving my paystub in electronic format from My Employer by way of My Employer’s online portal.

 

This authorization is to remain in full force and effect until My Employer and Bank have received written notice from me of its termination in such time and in such manner as to afford My Employer and Bank reasonable opportunity to act on it.

I agree that my action of clicking on the Submit button below, constitutes my authorization of this Direct Deposit Enrollment Form with the same force and effect as if I were to sign a printed copy of this Direct Deposit Enrollment Form.

I Authorize Direct Deposit by Submitting the Information Below

My Employer's Company PIN 4 digits (4 digits your employer gave you) *

My Employer's Company Name (Name of the company you work for) *

Legal Name *

Social Security Number (Format = XXX-XX-XXXX, including dashes) *

Email Address (to receive paystubs) *

1. Bank Name *

Routing/Transit Number (9 digits) *

Account Number (6-17 digits) *

Checking, Savings or Other Type of Account *

If Other Type of Account Explain

I wish to deposit *

I wish to deposit the following amount of my paycheck:

OR I wish to deposit the following percentage of my paycheck:

Optional - click below to upload an image of a voided check (checking accounts only):

Upload
Max File Size 15MB

Bank 2: (Optional) Remainder of paycheck will be deposited to the bank specified below:

Routing/Transit Number (9 digits)

Account Number (6-17 digits)

Checking, Savings or Other Type of Account

If Other Type of Account Explain

Optional - click below to upload an image of a voided check (checking accounts only)

Upload
Max File Size 15MB

Please click Submit only once.  It may take a moment to process

Easytrack Payroll LLC

245 Century Cir, Ste 205

Louisville, CO 80027

Phone: 303.222.0063

Fax: 303.558.3891

We take pride in our business community and go beyond your typical service by putting our heart and soul into helping you!

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