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Direct Deposit Request Form - Canada
SECTION A – Employee Information
Employee ID:
Last 3 digits of SIN:
First Name:
MI:
Last Name:

 

SECTION B – Payment Types
By enrolling in this service, I acknowledge that the following payment types will be electronically deposited into the bank account(s) listed on this form. Check all that apply.
Payroll
Commission
Bonuses		 Expense Reports
Advances

 

SECTION C – Account Information
Primary Checking Account: Complete this section with the bank account information that will be used to deposit your funds.
Bank Name:
 New    Change
Transit #:
Institution #:
Account #:
Swift Code:
Additional Checking Account(s): Complete this section if you want to designate a portion of your paycheck - dollar amount only - to be directly deposited into separate account(s).
Bank Name:
 New     Change
Transit #:
Institution #:
Account #:
Swift Code:
Dollar Amount or Percent:
$    or    %

 

I hereby authorize my employer to deposit any amounts owed me by initiating credit entries to my accounts at the financial institutions (hereinafter "Bank") indicated on this form. Further, I authorize Bank to accept and to credit any credit entries indicated 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 account. This authorization is to remain in full force and effect until my employer has received written notice from me of its termination in such time and in such manner as to afford my employer a reasonable opportunity to act on it.  I agree that direct deposit transactions I authorize comply with all applicable law. My signature below indicates that I am agreeing that I am either the accountholder or have the authority of the accountholder to authorize my employer to make direct deposits into the named account.
Employee's Signature

Checking the checkbox above is equivalent to a handwritten signature.