Payroll Direct Deposit Authorization Form - Maine School Administrative District 60
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1Maine School Administrative District #60
Payroll Direct Deposit Authorization Form
To enroll in direct deposit, simply fill out this form and send to Payroll. Attach a voided check for each checking account – not a deposit
slip. If depositing to a savings account, ask your bank to give you the Routing/Transit number for your account – it isn’t always the
same as the number on a savings deposit slip. All of the above will help ensure that you are paid correctly.
IMPORTANT! Please read and sign before submitting to Payroll.
I hereby authorize Maine School Administrative District #60, hereinafter called MSAD 60, to directly deposit any amounts owed to me,
by initiating credit entries to my account(s) at the Financial Institution(s) indicated on this form. Further, I authorize the Financial
Institution to accept and to credit any credit entries indicated by MSAD 60 to my account. In the event that MSAD 60 deposits funds
erroneously into my account(s), I authorize MSAD 60 to debit my account for an amount not to exceed the original amount of the
erroneous credit.
This authorization is to remain in full force and effect until MSAD 60 has received written notice of its termination in such time and in
such manner as to afford MSAD 60 reasonable opportunity to act on it.
Employee Name (print)
____________________________________________
Employee Signature
________________________________________________
Date: ______________
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New Setup
Change
Cancellation
Account Information: Please ensure that you indicate what kind of account, along with the amount to be deposited, if less than your
total net paycheck.
1.
Bank Name: __________________________________________________________________
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Checking
Savings
Routing/Transit Number:
___ ___ ___ ___ ___ ___ ___ ___ ___
Account Number:
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
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I wish to deposit: $_____________.___ or
Entire Net Amount
2.
Bank Name: __________________________________________________________________
□
□
Checking
Savings
Routing/Transit Number:
___ ___ ___ ___ ___ ___ ___ ___ ___
Account Number:
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
□
I wish to deposit: $_____________.___ or
Entire Net Amount
3.
Bank Name: __________________________________________________________________
□
□
Checking
Savings
Routing/Transit Number:
___ ___ ___ ___ ___ ___ ___ ___ ___
Account Number:
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
□
I wish to deposit: $_____________.___ or
Entire Net Amount
**
**
I elect to receive my electronic paystub delivery to the following:. _______ (Initials)
Email Address: __________________________________________________________
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Parent category: Financial