Employee Direct Deposit Form

Employee Direct Deposit Form

Direct Deposit Info & Agreement

Amicable Healthcare Inc. utilizes paperless payroll statements. If you are on Direct Deposit you will not receive a pay statement. In order to access your pay statement, you will need to register with ADP. Once registered, you can log in at your convenience to view/download your pay stub through our ADP portal.

Please register and create password. If you need help registering our office staff is ready to assist you.

On the ADP website you can also access company news, announcements, policies and more. The ADP website gives you access to 3 years’ worth of pay statements as well as W2’s. Please submit your bank information to the Human Resources Department to sign up for direct deposit. If you don’t have a bank account, we can offer you an ALINE card by ADP; please see Human Resources for more information.

Agreement

I hereby authorize Amicable Healthcare, Inc. (AHI) to initiate automatic deposits to my account at the financial institution named below. I also authorize AHI to make withdrawals from this account if a credit entry is made in error or overpayment.

Further, I agree not to hold AHI responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account.

This agreement will remain in effect until AHI receives a written notice of cancellation from me or my financial institution, or until I submit a new direct deposit form to the Payroll Department.

Account Information
Amicable Location You Were Hired From: *
9 digit code
Please choose one: *
Please attach an image of a voided check or deposit slip below. If you are unable to do this please submit a copy of a voided check or deposit slip to HR.
Maximum upload size: 516MB
I attest that all information provided above is accurate and complete.