Direct Deposit Form

"*" indicates required fields

All deposits have electronic pay stubs. View at www.zamphr.com

PLEASE NOTE: WE CANNOT DEPOSIT FUNDS INTO PRE-PAID DEBIT CARD ACCOUNTS

Company Name*

Employee Name*

Social Security #*

Action to be taken*

Enroll in a Pay Card

Add New Bank Account(s)

Delete Bank Account(s)

Change Bank Account(s)

Account 1

Bank Name

Checking or Savings Account?

Routing Number

Account Number

Amount of Net pay to be Deposited ($ or %)

Account 2

Bank Name

Checking or Savings Account?

Routing Number

Account Number

Amount of Net pay to be Deposited ($ or %)

Account 3

Bank Name

Checking or Savings Account?

Routing Number

Account Number

Amount of Net pay to be Deposited ($ or %)

I hereby authorize Zamp HR to transfer electronic debits or credits to the bank account(s) noted above. I authorize the institutions named to accept and process the debit or credit entries initiated by Zamp HR. Zamp HR shall have no liability if the information listed above is not correct. This agreement may be terminated at any time by written notification to Zamp HR with Zamp HR being allowed reasonable time to act. I certify that I have legal right to conduct any, and all business on the accounts listed above. Zamp HR reserves the right to stop this transfer if sufficient collected funds are not available. I grant Zamp HR the right to correct any erroneous overpayments by debiting my account to the extent of such overpayment. I understand that Zamp HR reserves the right to refuse any direct deposit request.

Signature*

Date*