ST. JAM ES R -l SCHOOL DISTRICT

AUTHORIZATION FOR DIRECT DEPOSIT

W e are pleased to be able to offer you Direct Deposit. You can have your paycheck autom atically deposited in your checking or savings account on payday. You do not have to change your present banking relationship to take advantage of this service. The electronic plan is dependable, flexible, convenient and easy. To take advantage of this service, com plete the authorization form below and return it to the payroll departm ent.

EMPLOYEE AUTHORIZATION I authorize the St. Jam es R - l School District to initiate electronic credit entries, and if necessary, debit entries to adjustm ent for any credit entries in error to m y financial institution listed below: _______CHECKING ACCO U N T

SAVINGS ACCO UN T

DATE__________________

This authorization will remain in effect until I cancel it in writing. Financial Institution___________________________________________ Branch___________________________ City_________________________________________State_________________________ Zip Code______________

Signature

Printed Name______________________________

ROUTING #______________________________________ ACCO UN T_____#_______________________________ Please attach a voided check to this docum ent