PLEASE ATTACHED VOIDED CHECK OR BANK ISSUED FORM

First Name:
Type of Action:
Direct Deposit Agreement Form
Last Name:
New
Add/Change
Cancel
Authorization Agreement
I hereby authorize Sherwood School District to initiate automatic deposits to my account at the financial institution named
below. I also authorize Sherwood School District to make withdrawals from this account in the event that a credit entry is
made in error.
Further, I agree not to hold Sherwood School District responsible for any delay or loss of funds due to incorrect or
incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in
depositing funds to my account.
This agreement will remain in effect until Sherwood School District receives a written notice of cancellation from me or my
financial institution, or until I submit a new direct deposit form to the Payroll Department.
Primary Account Information
Name of Financial Institution:
Type of
Account
Checking
Savings
Secondary Account Information
Name of Financial Institution
Type of Account
Checking
Savings
Amount:
Signature
Authorized Signature
Date:
PLEASE ATTACHED VOIDED CHECK OR BANK
ISSUED FORM HERE
PHYSICAL VOIDED CHECK OR FORM MUST BE TURNED IN WITH THE
FORM OR THE ACCOUNT WILL NOT BE SET UP
Fiscal Dept Use Only
Payroll – Entered by:
Revised 4/3/12
Date: