Payroll Authorization For Direct Deposit Into Employee'S Account/accounts Hr/cms Payrolls
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1PAYROLL AUTHORIZATION FOR DIRECT DEPOSIT
INTO EMPLOYEE’S ACCOUNT/ACCOUNTS
HR/CMS Payrolls
SECTION 1: Employee Information
Employee Name: ________ _____ _______ Department ID: NEC Employee ID: ________________
SECTION 2: Direct Deposit Information (fill in as necessary)
Instructions: Direct deposits are distributed to accounts in order of the priority starting with priority “1”.
The total of the percentages can not exceed 100%. Designate one (and only one) account to receive any
excess funds left over after all direct deposits are processed. Check “Partial Allowed?” to allow the direct
deposit amount to be less than the amount entered in the $ Amount or % of Net Pay fields.
Bank Name: ________________________________________________________
Percent of
Excess?
Partial
Checking
Priority Amount
Net Pay
(check one)
Allowed?
*Transit #
Account #
Savings
_ 1
$_____ or _______%
________
________
______
_ 2
$_____ or _______%
________
________
______
_ 3
$_____ or _______%
________
________
______
_ 4
$_____ or _______%
________
________
______
_ 5
$_____ or _______%
________
________
______
_ 6
$_____ or _______%
________
________
______
_ 7
$_____ or _______%
________
________
______
_ 8
$_____ or _______%
________
________
______
_ 9
$_____ or _______%
________
________
______
_ 10
$_____ or _______%
________
________
______
*NOTE: To find the Transit Number, look at the bottom of your personal check on the left side. You will
find the nine-digit transit number there. If it is a savings account, contact your back/credit union for help.
SECTION 3: Sign and Return to Your Payroll Supervisor
I hereby authorize my employer, through the State Treasurer, to deposit my net pay and/or deductions to
the financial institution/institutions listed above. My employer, through the State Treasurer, is also
authorized to debit any over deposit or error, which it has caused to be made to my account. The State
Treasurer or the employee may cancel this authorization anytime with proper notice to the Payroll
Supervisor.
Employee Signature:____________________________________
Date:_____________________
Employee Work Phone: _________________________________
2006-09-26
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