Direct Deposit Authorization Form I hereby authorize West Branch

Direct Deposit Authorization Form
I hereby authorize West Branch Community Schools to electronically credit
my account at the depository financial institution named below. I agree that
ACH transactions I authorize comply with all applicable law.
Financial Institution
Name:_______________________________________
Routing (ABA) Number:__ __ __ __ __ __ __ __ __
Account Number___________________________
Your financial institution routing number can be found on your check; it is the first nine digits on the lower
left of your check followed by your institution account number and check number.
Type of Account: Checking ____Savings
_____Amount:___________________
E Mail Address:
___________________________________________________
(Your paystub will be emailed to you.)
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
__ __ __
I hereby authorize West Branch Community Schools to initiate electronic entries, and if
necessary, debit entries, to my account with the financial institution indicated above. This
authority is to remain in full force and effect until West Branch Schools has received written
notification from me of its termination. A new authorization must be completed if I change my
account, close my account, or change financial institutions.
Signature:_________________________________________ Date:____________________
PLEASE ATTACHED VOIDED CHECK IF POSSIBLE