New Hire Package - Revised Employee Qualifications, Requirements, And Forms (Page 30 of 32) in pdf

New Hire Package - Revised Employee Qualifications, Requirements, And Forms Page 30

Direct Deposit Authorization for the CDS Program

INSTRUCTIONS: Please fill in the information requested below

 Send a copy of a voided check with this form If you do not use paper checks, have your financial

institution provide you with a form that indicates your bank account and routing numbers. This applies to

savings accounts as well. Your direct deposit will not be set up without a copy of a voided check or a form

from your financial institution.

 Fax or mail completed form to CDSA along with the copy of the voided check.

 Employees must keep the CDSA informed of any changes to the banking information in order to receive

their direct deposit without interruption.

 Please allow 2 to 3 payrolls weeks for the direct deposit to take effect.

Employer’s Name__________________________________ Date: _________________________

Initial Setup

Change

Cancel

Name of Employee:

Social Security Number:

Address (Street, Route, P.O. Box):

City, State, Zip Code

Telephone Number:

(

)

Type of Account:

Employee Account Number:

Checking

Savings

Name and Address of Financial Institution/Bank:

Routing Number:

CDSA Use:

I hereby authorize my CDSA to directly deposit my pay in the bank account listed above. This authorization is to

remain in force until the company has received written authorization from me of its termination or change. Also,

I grant my CDSA the right to correct my Electronic Funds Transfer resulting from an erroneous overpayment by

debiting my account to the extent of such overpayment.

Employee Signature:

Date:

PLACE CHECK COPY HERE: (or attach letter from financial institution)

Page 30--6/11/15

New Hire Package - Revised Employee Qualifications, Requirements, And Forms Page 30