Direct Deposit Please enable JavaScript in your browser to complete this form. - Step 1 of 2Employer NameEmployee Name *FirstLastEffective Date *AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSocial Security NumberPhoneEmailNextPayroll Deductions / Direct DepositsI request my payroll deduction/direct deposit be placed in the following accounts:Bank / Credit Union *Bank ABA (Routing)# *Account# *Choose Your Deduction MethodDeduction Amount% Net PayDeduction Amount% Net PayPayCard rapid! PayCard Issuance Authorization Form(Direct deposit number to be assigned and entered by Magnet HR Group)I authorize MAGNET HR GROUP, LLC to withhold the indicated amount(s), if available, from my pay, and deposit directly into the account(s) shown and/or I hereby authorize MAGNET HR GROUP, LLC to assign a rapid! PayCard and initiate credit entries and any correcting entries to my assigned rapid! PayCard account. The direct deposit(s) will be made on each payday, unless I notify MAGNET HR GROUP, LLC in writing of my intent to cancel. Upon MAGNET HR GROUP, LLC’s receipt of a request to cancel a direct deposit authorization, it shall become effective after a reasonable opportunity to act upon it. In the event funds are deposited erroneously into my account, I authorize MAGNET HR GROUP, LLC to debit my account(s) not to exceed the original amount of the credit. I understand that MAGNET HR GROUP, LLC reserves the right to refuse any direct deposit request. I also understand that all direct deposits are made through the Automated Clearing House (ACH), and that funds availability is subject to the terms and limitations of the ACH as well as my financial institution. Note: If sending this form electronically, please type your initials and the last 4 digits of your social security number in the signature field. If sending or faxing a paper copy, please print out and sign your name(s) in the signature box.NameSubmit4502 COMPANY About Us Careers NAVIGATION Services Resources Client Info Employee Info Contact Us CONTACT Office: 469-470-1077 Fax: 214-975-2331 4100 Spring Valley Road Suite 654 Dallas, TX 75035
