Direct Deposit Authorization Form printable pdf download

DIRECT DEPOSIT AUTHORIZATION FORM

To enroll in Direct Deposit, complete this form, sign, and date. Attach a voided check for each

checking account or written verification from the bank which includes the Bank Name, Account

Number, and Routing/Transit Number. If depositing to a savings account, ask your bank to give

you the Routing/Transit Number for your account. It is not always the same as the number on a

savings deposit slip. This will help ensure that your check is deposited correctly.

Below is a sample check, detailing where the information necessary to complete this form can be

found.

_______________________________________________________________________________

Account Information

If directing your paycheck to be deposited into two (2) separate accounts, make sure to indicate

what kind of account, along with the amount to be deposited into each account.

Bank Name/City/State:_______________________________________________________

Routing/Transit #: __ __ __ __ __ __ __ __ __

Account #: __ __ __ __ __ __ __ __ __ __ __ __ __

___ Checking ___ Savings

I wish to deposit: $_______ . ___ or ___ Entire Net Amount

Bank Name/City/State:_______________________________________________________

Routing/Transit #: __ __ __ __ __ __ __ __ __

Account #: __ __ __ __ __ __ __ __ __ __ __ __ __

___ Checking ___ Savings

I wish to deposit: $_______ . ___ or ___ Entire Net Amount

_______________________________________________________________________________

I authorize the Town of Morehead City and the financial institution(s) listed above to initiate

electronic credit entries and, if necessary, debit entries and adjustments for any credit entries in

error to the account listed below each payday. This authority will be ongoing. If I change banks, a

new Authorization Form will be required.

Employee Name (please print):______________________________________________________

Employee Signature: _____________________________________________________________

Direct Deposit Authorization Form