Direct Deposit Authorization

· Please complete this form and return it to the payroll department.

· Be sure to include a voided (Cancelled) check from your checking account and/or a deposit slip for your savings account, whichever is applicable. The details from the check / deposit slip will be used to verify the account details.

· You also have the option to deposit a part of your net pay into a secondary account, such as savings or credit union account. Please specify the dollar amount from your net pay that should be deposited in your secondary account.

Form fields: name, your bank/financial institution, social security number, city/state, primary account number, secondary account number, dollar amount, checking, savings, pay card

I authorize _______________________________________________ and the above Financial Institution to deposit my net pay and/or flat amount automatically into my account(s) each payday, and to initiate any necessary adjustments for entries made in error to my account.

___________________________________               ____________________
(Signature)                                                          (Date)

Attach Voided Check(s)/Deposit slip here.