employee-payroll

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What we collect and why

This intake captures your identity, pay arrangement, deductions, and bank details so we can set up your payroll record accurately. Your information is encrypted in transit and handled in confidence.

Your Information

Identifying details for payroll records

First Name *

Please enter your first name.

Last Name *

Please enter your last name.

Phone Number *

Please enter a valid phone number.

Email *

Please enter a valid email.

Date of Birth *

Please enter your date of birth.

Social Security Number *

Please enter a valid SSN.

Masked for privacy. Stored encrypted.

Gender *

Please select an option.

Compensation

How and how much you are paid

How often are you paid? *

Please select your pay frequency.

Salary amount *

Please enter your salary amount.

The amount per pay period you selected above.

III

Payroll Deductions

Pre-tax and other deductions

Do you have payroll deductions? *

Please select an option.

Selecting Yes will reveal a checklist of common deduction types.

Direct Deposit Authorization

Where your pay will be deposited

Authorization. By providing the information below and submitting this form, you authorize your employer and its payroll processor to initiate direct deposits of your pay to the account you designate. This authorization remains in effect until you revoke it in writing. You confirm the account information you provide is accurate and that you are authorized to receive deposits to this account.

Name on Account *

Please enter the name on your account.

Type of Account *

Please select an account type.

Routing Number *

Please enter a valid 9-digit routing number.

Account Number *

Please enter your account number.

Upload a Voided Check *

Browse Files

PDF or image — confirms your account details

Please upload a voided check.

Signature & Date

Confirm and sign

Full Legal Name (Signature) *

Please type your full legal name.

Typing your name here serves as your electronic signature.

Date *

Please confirm the date.

I confirm that the information provided in this form is accurate and complete to the best of my knowledge. I authorize FIRM1040 and my employer to use this information for payroll setup and processing.

Please acknowledge before submitting.

By submitting, you authorize FIRM1040 and your employer to use the information above for payroll setup and direct deposit. Your data is encrypted in transit.