County Of Sonoma - Payroll Direct Deposit Application

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County of Sonoma - Payroll Direct Deposit Application
Clear form
Name
(Print
Last Name, First Name)
5-digit Empl
oye
e ID Number
Web Stub - Go Green!
Discontinue your paper pay stub and reduce paper consumption. Current and past pay stubs can
be accessed in Employee Self-Service. Pay stubs are available at 12:01 a.m. on pay day.
Primary Account
Checking
Savings
Bank Name
Start Direct Deposit
Change Direct Deposit
Stop
Direct Deposit
2nd Account
Checking
Savings
(Flat Amount)
Bank Name
Start Direct Deposit Amount
$_____
_
_____
_
Stop
Direct Deposit
Change Direct Deposit Amount $ ____________
3rd Account
Checking
Savings
(Flat Amount)
Bank Name
Start Direct Deposit Amount $__________
__
Stop
Direct Deposit
Change Direct Deposit Amount $
________
____
4th Account
C
hecking
Savings
(Flat Amount)
Bank Name
Start Direct Deposit Amount $____________
Stop
Direct Deposit
Change Direct Deposit Amount $____________
Please attach a voided check or form letter from your bank. The attached form must
include the bank routing number and account number.
Automatic Payroll Deposit or Stop Authorization
I hereby authorize the Auditor-Controller Treasurer-Tax Collector’s office to initiate credit
entries and to initiate, if necessary, debit entries and adjustments for any credit entries in
error to the above bank account and the depository as shown.
or
I hereby request that the direct deposit indicated above be discontinued effective on the
first pay date after receipt of this request by Auditor Payroll.
Signature
Phone #
Da te
I understand that I will receive one regular paycheck before direct deposit to my new account takes place.
2012 DirDeposit w eb stub.doc
rev 7/12/12 AUD-pay

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