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Automatic Payroll Deposit Authorization

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AUTOMATIC PAYROLL DEPOSIT AUTHORIZATION

Please print!

Name ___________________________

Action



ID or SSN #_____________________

Start



Department ______________________

Change

Please fill out and sign the bottom of this form and return to the payroll office along with a VOIDED

CHECK(S) from your account(s). The system requires that we test each new account as it is set up so you

should expect that direct deposit will take effect no earlier than the second payday after our receipt of

this form.

You may split the direct deposit of your net pay to two different banks. You must specify a dollar amount

for the first account and the remainder of your pay will be deposited to the second account. You may not

split your net pay between two different accounts at the same bank, as most banks have a process for

automatic transfers from one account to another.

Account: Bank Name

Amount

$________



Checking

Savings

Account: Bank Name _________________________________

Amount

Remainder



Checking

Savings

EXAMPLE:

Account:

Bank Name Bank of America

Amount $500.00





Checking

Savings

Account: Bank Name Wells Fargo

Amount Remainder





Checking

Savings



Please indicate if you would like to pick up check

or have check mailed

until direct deposit goes

into effect.



or put in NVC mailbox

Once direct deposit is in effect I would like my pay stub mailed

I hereby authorize Napa Valley College to provide for direct deposit of any wages due me, less the mandatory or

authorized withholding(s), deductions and/or corrections to previous deposits, in the above designated account. If

any action taken by me results in a rejection of a direct deposit, I understand that Napa Valley College assumes no

responsibility for processing a supplemental salary or wage payment until the amount of the rejected deposit is

returned to Napa Valley College by the financial institution.

Employee Signature_____________________________

Date_____________________

Automatic Payroll Deposit Authorization

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