To enroll in Full Service Direct Deposit, fill out this form and give it to your payroll manager. Attach a voided check for each checking account – NOT A DEPOSIT SLIP. If depositing to a savings account, ask your bank to give you the Routing/Transit Number for your account. It isn’t always the same as the number on a savings deposit slip. This will help ensure that you are paid correctly.
Below is a sample of a check MICR line, detailing where the necessary information to complete this form can be found.
I hereby authorize Medical Staffing Partners 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 Medical Staffing Partners to my accounts. In the event that Medical Staffing Partners deposits funds erroneously into my account, I authorize Medical Staffing Partners to debit my account for any amount not to exceed the original amount of the erroneous credit.
This authorization is to remain in full force and effect until Medical Staffing Partners and Bank have received written notice from me of its termination in such time and in such manner as to afford Medical Staffing Partners and Bank reasonable opportunity to act on it.
Routing/Transit #:
Account #
Attention Payroll Manager: Employers must keep each original employee enrollment form on file as long as the employee is using FSDD, and for two years afterwards.
