Direct Deposit Application

Employee Name:

Employee Number:

Instructions: Complete Section 1 to initiate a direct deposit to a single account (total net wages), or to ini-tiate a primary account (portion of wages) associated with a second direct deposit identified in Optional Section 2, as well as a possible third deposit in Optional Section 3. To apportion two or three accounts, a specific amount must be shown in Optional Section 2 and Optional Section 3, in addition to satisfying the informational requirements of Section 1. The balance of all wages beyond those allocated through Optional Sections 2 and 3 will be deposited in the account cited in Section 1. Voided checks or an equivalency should be provided for each individual Direct Deposit Request.


Section 1:

 

 

Bank Name:

City:

State:

Routing #:

Account #:


Optional Section 2: Use Optional Section 2 for a specific amount to be deposited to a second checking or saving account.

Specific Amount: $

 Account Type: Checking    Saving

Bank Name:

City:

State:

Routing #:

Account #:


Optional Section 3: Use Optional Section 3 for a specific amount to be deposited to a third
checking or savings account.

Specific Amount: $

 Account Type: Checking    Saving

Bank Name:

City:

State:

Routing #:

Account #:

Payee Certification:
By signing below, I authorize RiteNet, Corp. and the Financial Institutions cited above to credit automatically to the indicated account all net pay amounts payable to me by the company. If funds to which I am not entitled are deposited into my account, I authorize the company to direct the Financial Institution to return said funds.  This Direct Deposit authority is to remain in force until I notify the Company in writing of termination or changes hereto.

Employee Signature:

Date:

Submit completed form with attachments to Human Resources

CLICK THE “PRINT” BUTTON AND FAX FORM TO RITENET

 

Form # Rnet/BM&HR/044
Issue # 1
Rev. 0 Date: 9/25/2001 Page: 1 of1