direct deposit authorization form please attached voided check(s) here

DIRECT DEPOSIT
AUTHORIZATION FORM
________________________________
______________________________________
Last Name
_________________
First Name
Middle Initial
I hereby authorize the Ritenour School District to initiate electronic credit entries, and if necessary, debit entries
and adjustments for any entry made in error to my account(s) indicated below for each pay period.
Account Type
Name of Financial
Institution
Account #
Amount/Remaining
Balance or Percent
1. K Savings K Checking
2. K Savings K Checking
3. K Savings K Checking
The authorization is to go into effect at such time as to allow the District and my depository reasonable time to act
on it. It is to remain in full force and effect until the District has received written notification from me of any
changes in such timely manner as to allow the District and my depository reasonable opportunity to act on it.
_________________________________________________________________
_______________________
Employee Signature
Date
PLEASE ATTACHED VOIDED CHECK(S) HERE
OR FOR SAVINGS ACCOUNT – ATTACH SAVINGS DEPOSIT SLIP
(See reverse side for more information)
06/08
For assistance in completing this form, please contact the District’s payroll office.
• A process known as electronic funds transfer accomplishes the payroll deposit authorized by the
employee’s signature from this form. It is covered by a number of federal regulations designed to
safegaurd the integrity of the employee’s account.
• The funds deposited should be available to the employee for withdrawal by all regular means on the
morning of the scheduled district pay date.
• The electronic funds transfer system requires an additional step known as pre-notification. Simply stated,
this is a procedure whereby account numbers must be verified by the receiving financial institution
before we transmit direct deposit data to them. Until the authorization can be processed, the employee
will continue to receive a payroll check.
• The pre-notification process also dictates that if a change in financial institution or account number is
made, the employee may be off direct deposit for a minimum of one pay period before the change will
take effect. For that payday(s) the employee will receive a payroll check.
• Employees may choose several fixed amount or percent direct deposits, as well as one net pay or balance
direct deposit after all fixed amount or percent direct deposits. This form accommodates up to three
accounts. For more than three accounts, use additional form(s) as necessary.
Examples:
Account Type
Name of Financial
Institution
Account #
Amount/Remaining
Balance or Percent
2. K Savings X
K Checking
Bank of America
123456
$25.00
St. Johns Bank
455555
Balance
Account Type
Name of Financial
Institution
Account #
Amount/Remaining
Balance or Percent
Bank of America
123456
25%
3. X
K Savings K Checking
St. Johns Bank
455555
25%
St. Johns Bank
557889
50%
Account Type
Name of Financial
Institution
Account #
Amount/Remaining
Balance or Percent
St. Johns Bank
455555
100%
1. K Savings X
K Checking
3. K Savings K Checking
1. K Savings X
K Checking
2. K Savings X
K Checking
1. K Savings X
K Checking
2. K Savings K Checking
3. K Savings K Checking
06/08