Direct Deposit Authorization Form

Account #1 Name of Bank:

____________________________________________________________

Account #:

____________________________________________________________

9-Digit Routing #:

____________________________________________________________

Amount:

 $ ____________

Type of Account:

Checking

Account #2 Name of Bank:

____________________________________________________________

Account #:

____________________________________________________________

9-Digit Routing #:

____________________________________________________________

Amount:

 $ ____________

Type of Account:

Checking

Savings

Savings

 ____________% or Entire Paycheck (Circle One)

 ____________% or Entire Paycheck (Circle One)

Please attach a voided check for each bank account to which funds should be deposited. Benson Unified School District is hereby authorized to directly deposit my pay to the account listed above. This authorization will remain in effect until I modify or cancel it in writing. Employee Signature: _______________________________ Date: ________________ Printed Name:

_______________________________

PLEASE NOTE THAT EVEN THOUGH YOU HAVE SELECTED DIRECT DEPOSIT, YOUR FIRST PAY WILL BE IN THE FORM OF A CHECK, SINCE WE ARE REQUIRED TO PRENOTE (TO MAKE SURE THAT ACCOUNT INFORMATION IS CORRECT) WITH THE BANK. PLEASE INITIAL HERE THAT YOU ARE AWARE OF THIS: ___________