Direct Deposit of Payroll Form the bank(s) as indicated above. This

New
Change
YMCA of Greater Louisville
Branch: _____________
Direct Deposit of Payroll Form
Please Print or Type all Information
Name: ___________________________________________________________
Emp #:_______________
Bank Information:
If two accounts are to be used, put a dollar amount to deposit into one account. The balance of your check will
be deposited to the other account. No amount needs to be entered if only one account is used. Please furnish
a voided check or savings deposit slip (or a copy). IF YOU PROVIDE THE YMCA WITH A DEPOSIT TICKET FROM THE
BANK, PLEASE MAKE SURE TO INCLUDE THE BANK ROUTING NUMBER ON THE DIRECT DEPOSIT FORM.
Bank #1
Name:
Account #:
City:
Checking
Savings Deposit Amount: $
Bank Routing #:
Bank #2
Name:
Account #:
City:
Checking
Savings Deposit Amount: $
BALANCE
Bank Routing #:
Direct Deposit Agreement
As an employee of the YMCA of Greater Louisville, I agree to have my paycheck electronically deposited to
the bank(s) as indicated above. This information may be changed by me at any time in the
future with a new form signed and submitted to the Association Services Office at least
14 calendar days prior to the next pay date. I realize it is my responsibility to notify the YMCA of
any changes in my banking information. In addition, I authorize the YMCA to recover any erroneous deposits
from my account(s), should they occur.
In the event my bank account is closed for any reason, I understand that I must provide a new Direct Deposit form or submit a
form authorizing the YMCA to deposit my pay onto a Total Pay card. I understand that my direct deposit will not be stopped
until one of the two requirements has been met.
Signature:
Date:
TAPE VOIDED CHECK
PLEASE DO NOT STAPLE
Direct Deposit Form
Revised 09/04/2009
DirDepForm.doc 11/03