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Company Name is hereby authorized to directly deposit my pay to the account listed above This authorization will remain in effect until I modify or cancel it Complete this form, then print it, sign it and take it to your employer's payroll department to request direct deposit of your paycheck. Customer name. Address.

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1 6 Of 18By completing this form, you consent for [company name] to deposit your wages, minus applicable taxes, directly into your bank account on a ... DIRECT DEPOSIT AUTHORIZATION LAST NAME FIRST NAME MIDDLE INITIAL BANK NAME AND BRANCH BANK ACCOUNT NUMBER BANK ROUTING NUMBER

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