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AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITS NYE COUNTY TREASURER’S OFFICE PO BOX 473, Tonopah, NV 89049 (775) 482-8147 / Fax (775) 482-8193 Nye County Payroll Please tell us how you would like your checks to be delivered by filling in the appropriate sections below. Please fleet my check to department in Please mail my check to my home address. Please email my direct deposit paystub to email This authority is to remain in full force and effect until Nye County Treasurer’s Office has received written notification from me of its termination in such time as to afford Nye county Treasurer’s Office a reasonable opportunity to act on it. Signed: Date: Treasurer’s office date received & completed: Employee Name: Social Security Work Phone Home Phone Mailing Address: Department: Position: AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITS I hereby authorize Nye County Treasurer’s Office to initiate credit entries and to initiate, if necessary, debit entries and adjustments for any credit entries in error to my account indicated below and the depositor financial insitution named below. I am a new direct deposit customer I am making a change to my existing direct deposit: Adding additional account Dropping account Change deposit amount Please cancel my direct deposit entirely, effective: Account Checking Savings Bank name: Branch: Phone Branch address: Routing Account Amount Per Pay Day: Account Checking Savings Bank name: Branch: Phone Branch address: Routing Account Amount Per Pay Day: Please attach a voided check or copy of check to this form. This form will not be processed unless all information is complete. Example