Direct Deposit Authorization Form

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DIRECT DEPOSIT AUTHORIZATION FORM
DISTRICT 5 SCHOOLS OF SPARTANBURG COUNTY
NAME:___________________________ SOCIAL SEC NO: _____________________________
(Please Print)
(Very Important)
SCHOOL/LOCATION: _____________________
I hereby authorize DISTRICT FIVE SCHOOLS, hereinafter called “District”, to initiate credit entries or debit
corrections to my bank account(s) indicated below and the financial institution(s) named below to credit same to
such account(s).
PRIMARY ACCOUNT Financial Institution: ______________________________________
City, State: _______________________________________________________
Bank Transit/ABA Number: _________________________________________
Account No.: ______________________________________________________
Type of Account: ____ Savings ____ Checking ____ Other
: *
A
D
Net Pay/Balance of net pay
MOUNT OF
EPOSIT
SECONDARY ACCOUNT: Financial Institution: ____________________________________
City, State: _________________________________________________________
Bank Transit/ABA Number: ___________________________________________
Account No.: _________________________________________________________
Type of Account: ____ Savings
____ Checking ____Other
A
D
: $_____________
MOUNT OF
EPOSIT
(Attach a voided check or Account Card from financial Institution for each account)
The authority is to remain in full force and effect until Company has received written notification from me of its
termination in such time and in such manner as to afford the District a reasonable opportunity to act upon it.
th
IMPORTANT NOTICE: Changes must be received by payroll by the 10
of the month to reflect in that month’s pay.
Upon payroll’s receipt of this Direct Deposit Authorization Form, a mandatory test must be completed using the
REAL CHECK
account numbers. This test will be done with the next regular payroll scheduled. A
(for Primary
Account only) will be issued until a successful test of the numbers has been completed. Amounts requested to be
deposited into a Secondary Account will be included in with the month’s net pay until a successful test is completed.
______________________________________________
____________________________
(Employee Signature)
(Date)
In the event the net pay for the month is insufficient to deposit the entire amount designated to the Secondary
Account, no funds will be deposited into the Secondary Account. In this case, he entire net pay will be
deposited into the Primary Account.
P:\FORMS\DIRECT DEPOSIT AUTHORIZATION

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