Fillable City Of Houston - Direct Deposit Authorization printable pdf download

City Of Houston - Direct Deposit Authorization

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New to direct deposit program

City of Houston

Add/change/delete existing direct deposits

DIRECT DEPOSIT AUTHORIZATION

Stop all direct deposit effective: _______

(Used only for Finance-approved exceptions)

*All shaded areas must be completed

Employee No*

Employee name (last, first, middle initial)*

Dept name*

Work Phone*

Action

Bank ABA Routing Number*

Account Number*

Deposit Type

Account Type*

(9 digits)

(up to 17 characters)

Add

Amount $_________

Checking

Change

Percent _________%

Savings

Delete

Balance

Effective Date

Financial Institution (name, city, state)

Action

Account Number*

Deposit Type

Account Type*

Bank ABA Routing Number

(9 digits)

(up to 17 characters)

Add

Amount $_________

Checking

Change

Percent _________%

Savings

Delete

Balance

Effective Date

Financial Institution (name, city, state)

Action

Bank ABA Routing Number

Account Number*

Deposit Type

Account Type*

(9 digits)

(up to 17 characters)

Add

Amount $_________

Checking

Change

Percent _________%

Savings

Delete

Balance

Effective Date

Financial Institution (name, city, state)

IF YOU SELECTED CHECKING ACCOUNT, ATTACH A VOIDED CHECK TO THIS FORM. IF YOU SELECTED SAVINGS ACCOUNT, ATTACH A DEPOSIT SLIP TO THIS FORM.

(NOTE: DO NOT ATTACH THE DEPOSIT SLIP IF IT DOES NOT HAVE PRE-PRINTED BANK AND ACCOUNT NUMBERS.

* Adding a new direct deposit or changing account type, bank identification number or account number requires a prenote to be sent to the bank before the add or change becomes affective. A prenote sends your

account type, bank ID and account number to the bank to assure the accuracy of the numbers. Changes should be effective 5 to 15 days after the agency enters the direct deposit in the payroll system. You may

receive warrants until the prenoting process is complete.

Remarks

I authorize the City of Houston and my financial institutions indicated above to initiate electronic credit entries (direct deposit) of the amounts I designated and if necessary, debit entries and adjustments

for any credit entries made in error to my accounts as I indicated above. I understand that this authorization will cause any previously authorized direct deposits to financial institutions to be

discontinued.

Employee Signature*

Date *

Send this form to your agency direct deposit designee. If you are not sure who this is, contact your payroll or personnel office.

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