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County of Alpine Direct Deposit Activation Information PLEASE PRINT Employee Name: Address: Financial Institution: Branch Address: Branch Phone Number (with area code): Effective Date of Activation: Indicate whether pay is to be deposited into a checking or savings account. For your checking account, a voided check must be attached to this form. For savings account, please obtain the correct transit routing and account number from your financial institution. I hereby authorize my employer, Alpine County, to initiate deposits (or correcting entries to previous deposits) to my account. Select One: □ Checking □ Savings This authority is to remain in force until I revoke it by giving written notice to my employer or upon my termination of my employment. Employee Authorized Signature: Date: Additional Instructions: