Direct Deposit Request Form
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1Direct Deposit Request Form
Eligibility
Cancellations
1.
All employees who receive a semi-monthly
1.
Employee may cancel in writing at any time
pay check
2.
Supervisor and/or treasurer may request cancellation
2.
Copy of voided check, deposit slip or bank
for just cause.
account card MUST be attached
Closing Bank Account
3.
Direct deposit may be split between accounts
1.
Employee must notify Treasurer in writing at least
Deposits
3 weeks prior to closing account.
1.
Fed-Wire deposits paychecks with an
2.
Treasurer accepts no fault or liability if account is
effective date the same as pay day.
closed without proper notification
2.
Direct Deposits will be sent as Pre-note (test)
3.
Re-Issue of direct deposit may be processed upon
on the next available payroll processing date.
return of funds from receiving bank.
3.
Direct Deposit should be in effect on the
payroll after the Pre-note unless the bank
rejects the test file.
Re-issuance can take up to 30 days
4.
On pay day, it is Employee responsibility to
verify funds have been received in their
Account.
TO BE COMPLETED BY EMPLOYEE
ATTACH A COPY OF CHECK, DEPOSIT SLIP OR BANK CARD
Bank Name: _________________________________________ Bank Phone: ________________________
Bank Account: _______________________________________ Bank ABA # ________________________
Amount: ENTIRE CHECK
Circle one:
Checking
Savings
Bank Name: _________________________________________ Bank Phone: ________________________
Bank Account: _______________________________________ Bank ABA # ________________________
Amount: __________________
Circle one:
Checking
Savings
Bank Name: _________________________________________ Bank Phone: ________________________
Bank Account: _______________________________________ Bank ABA # ________________________
Amount: __________________
Circle one:
Checking
Savings
Bank Name: _________________________________________ Bank Phone: ________________________
Bank Account: _______________________________________ Bank ABA # ________________________
Amount: __________________
Circle one:
Checking
Savings
Employee: _______________________Date: ___________________ Dept: __________________
Employee Signature: __________________________________________
To be Completed by Treasurer Staff
Pre-note pay date: ____________ Effective Pay Date: ________________
Processed by: _______________________________________________
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Parent category: Financial