Authorization Agreement For Direct Deposit Form - Kansas City, Kansas Housing Authority
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1KANSAS CITY, KANSAS HOUSING AUTHORITY
AUTHORIZATION AGREEMENT FOR DIRECT DEPOSIT
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I hereby authorize and request the Kansas City, Kansas Housing Authority, hereinafter called the KCKHA, to make payment of any amounts
owed to me by initiating credit entries to my account indicated below in the bank named below, hereinafter called the BANK, and I authorize and
request the BANK to accept any deposits initiated by the KCKHA to such account and to credit the same to such account without responsibility
for the correctness thereof. In the event of an overpayment in error, I hereby authorize the KCKHA to initiate correcting entries to my account
in the amount of such payment in error.
EMPLOYEE NAME: ___________________________________________________
SOCIAL SECURITY #: |__|__|__| - |__|__| - |__|__|__|__|
SIGNATURE: ______________________________________________
DATE:__________________________
Direct Deposit Checking __
Savings __
Credit Union __
Deferred Comp __
Other __________________________ __
Bank Name _________________________________________
Transit Routing # |__|__|__|__| |__|__|__|__| |__|
Flat Amount $________________
Account Number |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Percentage __________________
Direct Deposit Checking __
Savings __
Credit Union __
Deferred Comp __
Other __________________________ __
Bank Name _________________________________________
Transit Routing # |__|__|__|__| |__|__|__|__| |__|
Flat Amount $________________
Account Number |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Percentage __________________
Direct Deposit Checking __
Savings __
Credit Union __
Deferred Comp __
Other __________________________ __
Bank Name _________________________________________
Transit Routing # |__|__|__|__| |__|__|__|__| |__|
Flat Amount $________________
Account Number |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Percentage __________________
Direct Deposit Checking __
Savings __
Credit Union __
Deferred Comp __
Other __________________________ __
Bank Name _________________________________________
Transit Routing # |__|__|__|__| |__|__|__|__| |__|
Flat Amount $________________
Account Number |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Percentage __________________
Direct Deposit Checking __
Savings __
Credit Union __
Deferred Comp __
Other __________________________ __
Bank Name _________________________________________
Transit Routing # |__|__|__|__| |__|__|__|__| |__|
Flat Amount $________________
Account Number |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Percentage __________________
OFFICE USE ONLY
PLEASE SEND COMPLETED FORM AND A VOIDED CHECK
Department # ________________
FOR EACH BANK ACCOUNT TO THE PAYROLL DEPARTMENT.
Initial:
________________
Date Entered: ________________
Form F-150 (06/02)
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