Authorization Agreement For Direct Deposit Of Paycheck Form

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AUTHORIZATION AGREEMENT FOR DIRECT DEPOSIT OF
PAYCHECK
1.
Read and fill-in the following Authorization Agreement.
2.
The bank you specify must be a member of an Automated Clearing House. Contact your bank to obtain their
Bank Code.
3.
Determine where you want your paycheck deposited. You may have it deposited in any of your existing savings
or checking accounts.
4.
Provide details concerning your existing bank account.
For an existing checking account: Attach an unsigned personal check with the word “VOID” written across the
5.
face of it. Do not sign the check.
6.
Return the completed Authorization Agreement directly to the Payroll Office (SJU Annex, Suite 21).
Please sign me up for Direct Deposit of my Paycheck. I authorize my employer to deposit my paycheck each pay
day directly into the account named below. This authority will remain in force until I have given written notice that I
have terminated it or until my employer has notified me that this deposit service has been terminated. I understand
that I must give advance notice to allow reasonable time for my instructions to be executed. If ever an incorrect
amount should be entered into my account, I authorize St. John’s University to make the appropriate adjustment to
my bank account or to deduct any overpayment from my pay
Please print:
Name ____________________________________________________
Social Security # _________________
Title __________________________________________
Dept. _________________________ Ext._______
Address ___________________________________________________
City __________________________
State ______________________________________
Zip code ___________________________
1
Each payday, please deposit the following into the bank account listed below
0.00%
Entire paycheck amount
or
$ ________________ Amount
Bank code | : |___|___|___|___|___|___|___|___|___| : |
Bank Name________________________________
Your bank’s code (ABA number) appears at the bottom of your check
between the marks indicated.
Account # ____________________________________
Checking
Money Mkt.
Savings
Branch Address _____________________________________________________________________________
_____________________________________________________________________________
Signature_________________________________________________________
Date________________
1
Complete a separate Agreement Authorization for each bank account (max. of 2).
SJU AADD
09/2015

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