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    13 views1 page

    Direct Deposit

    Uploaded by

    pedro_alamancha
    Blank form

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    TownSportsInternational,Inc.

    PAYROLLDIRECTDEPOSITAUTHORIZATIONFORM

    EMPLOYEENAME:________________________________________________________________________
    EmployeeFile#:________________________

    Club/Location:_______________________________

    INSTRUCTIONS
    Forcheckingaccountdeposits,pleaseSUBMITAVOIDEDCHECKWITHTHISAUTHORIZATIONFORM.Forsavingsaccountdeposits,please
    forwardastatementofaccountletterfromyourbankoraphotocopyofthetopportionofyourbankstatementreflectingyouraccountand
    routingnumbers.Ourbankscannotprocessyourdepositwithoutthisinformation.Youmaydistributeyournetpaytoasmanyas3accounts.

    PLEASESUBMITTHECOMPLETEDFORMANDDOCUMENTATIONVIAEMAILTOTHEPAYROLLDEPARTMENTFORPROCESSINGAT:
    .PAYROLL@TOWNSPORTS.COM,VIAFAXTO:(914)3474701,ORINPERSONTOYOURCLUBMANAGER.

    NOTE: PayrollfundswillbeavailableanddepositswillbereflectedonFriday(paydate)forCHASEBANK,orSaturdayfor
    otherbankinginstitutions.Shouldyouraccountinformationchange,pleasenotifythepayrolldepartmentimmediately.

    AUTHORIZATION
    Thisservesasyourauthorizationtodepositmynetpay,ortheamountindicated,automaticallyintomyaccount(s)eachpayday.Iffundsto
    whichIamnotentitledaredepositedintomyaccount(s),IauthorizeTSI,Inc.todirectthebanktoreversesaidfunds.Thisauthoritywillremain
    ineffectuntilInotifyTSI,Inc.inwriting,ofmydesiretocancelthisauthorization.

    Account1:

    ACCOUNTNO.:____________________

    AMOUNT$:__________

    ACOUNTTYPE:(PLEASESELECT)

    SAVINGS:____ CHECKING:____

    BANK_____________________________________________________
    ABARouting#______________________________________________

    Account2:

    CITY______________________________

    STATE________________

    ACCOUNTNO.:____________________

    AMOUNT$:__________

    ACOUNTTYPE:(PLEASESELECT)

    SAVINGS:____ CHECKING:____

    BANK_____________________________________________________
    ABARouting#______________________________________________
    CITY______________________________

    STATE________________

    ACCOUNTNO.:____________________

    AMOUNT$:__________

    ACOUNTTYPE:(PLEASESELECT)

    SAVINGS:____ CHECKING:____

    Account3:

    BANK_____________________________________________________
    ABARouting#______________________________________________
    CITY______________________________

    STATE________________

    EMPLOYEESIGNATURE:_______________________________________

    DATE:_________________________

    PayrollUseOnly:

    DateReceived:_______________ Initials:______

    DateProcessed:_______________Initials:__________

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