Payroll Payment Option Form
For Active Personnel Only
Payroll Fax #: 404-773-3427
Questions? Call 404-773-4430
Employee Name: ______________________________________________
Social Security Number: __ __ __ - __ __ - __ __ __ __
Employee Number: __ __ __ __ __ __ __
□ Direct Deposit:
Please complete the following information and return to Payroll, Attn: Direct Deposit Coordinator, Dept. 937, ATL (DGS) with a voided check from the checking
account or deposit slip from savings account to which your net pay will be deposited.
1st Account
□ New Authorization
□ Change in Financial Institution and/or Account #
□ Cancellation
Routing # __ __ __ __ __ __ __ __ __
□ Checking (attached voided check) OR □ Savings (attach completed deposit slip)
□ 100% of Net OR □ $___________ OR □ Balance
Account #: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
(only use # of spaced needed for Account #)
Attach your voided check here
2nd Account
□ New Authorization
□ Change in Financial Institution and/or Account #
□ Cancellation
Routing # __ __ __ __ __ __ __ __ __
□ Checking (attached voided check) OR □ Savings (attach completed deposit slip)
□ 100% of Net OR □ $___________ OR □ Balance
Account #: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
(only use # of spaced needed for Account #)
□ ADP Pay Card
ABA Routing #: __ __ __ __ __ __ __ __ __
Direct Deposit Account #: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
□ Checking (attached voided check) OR □ Savings (attach completed deposit slip)
□ 100% of Net OR □ $___________ OR □ Balance
□ New Authorization
□ Change in Financial Institution and/or Account #
□ Cancellation
I authorize DAL Global Services, Inc. and the financial institution named above to credit my account for direct deposit of net pay, and if
necessary, to initiate debit or adjustment entries for credits made in error. I will not hold my bank liable for any erroneous deposits or
adjustments by DAL Global Services, Inc., and I agree that the financial institution listed above may treat each deposit the same as if it were
personally deposited by me. This authority will remain in effect until the Payroll Department receives in writing a cancellation or change request
from me.
For the ADP Payroll Card option, I consent to receive my wages by electronic transfer to my payroll card. I acknowledge that I have received a
copy of the Cardholder Agreement and a schedule of the fees I will incur using my card.
□ I have read and understand this agreement and the information on the bottom of this form.
_____________________________________________________
_______________________
Signature
Date