Direct Deposit Form
ADVERTISEMENT
1
2DIRECT DEPOSIT FORM
(FAX OR XEROX COPIES ARE NOT ACCEPTABLE)
TO QUALIFY: YOU MUST BE A REGULAR STATUS EMPLOYEE.
HAVE COMPLETED YOUR 90 DAYS PROBATION PEIORD.
TEMPORARY EMPLOYEES ARE NOT ELIGIBLE.
TO:
THE NAVAJO NATION
INCOMPLETE FORMS WILL NOT BE
Payroll Department
PROCESSED. Form will be mail back to the
employee’s address listed by the Personnel dept.
P.O. Box 3150
Window Rock, AZ 86515-3150
nd
Direct deposit enrollments will begin with the 2
payroll following this request.
(Direct deposit enrollments, updates & cancellations, are processed every pay period ending.)
NAME: ___________________________________
SOCIAL SECURITY NO. ____________________
DEPT.
DEPT.
WORK
NAME: ___________________________________
NO.: ________
PHONE: ______________________
You may designate up to two accounts only, and can be affiliated with two different banking institutions.
CHECK TYPE OF ACCOUNT:
CHECK TYPE OF ACCOUNT:
[ ] PRIMARY CHECKING
[ ] SECONDARY CHECKING
[ ] PRIMARY SAVINGS
[ ] SECONDARY SAVINGS
CHECK ONE SELECTION:
CHECK ONE SELECTION:
[ ] START [ ] CHANGE*
[ ] START [ ] CHANGE* [ ] CANCEL
AMOUNT: 100% or the remainder.
DOLLAR AMOUNT ONLY: $_____________
ACCOUNT NUMBER: _____________________
ACCOUNT NUMBER: ____________________
ROUTING NUMBER: ______________________
ROUTING NUMBER: ____________________
BANK NAME: ____________________________
BANK NAME: ___________________________
will stop your direct deposit
Adding an account &/or changing your banking information
*
for one pay period. You will receive a regular paycheck from your department.
Page 1 of 2
Revised 4/22/2010
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial