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CITY OF PUYALLUP DIRECT DEPOSIT AUTHORIZATION AGREEMENT EMPLOYEE EMPLOYEE ID: I hereby authorize the City of Puyallup to make payroll deposits to my bank account indicated below. NAME ON ACCOUNT: BANK NAME: BRANCH: CITY: STATE: ZIP: AMOUNT PER PAY PERIOD (IF LEFT BLANK = 100% OF NET PAY) CHECKING BANK TRANSIT ABA OR SAVINGS ACCOUNT NUMBER: NOTE: If this is a replacement for an existing direct deposit, please indicate whether the current account is to remain open while we test the new account. 1. Keep existing account open while testing the new account. 2. Give me a cashable check while testing the new account. OR 3. This is in addition to current direct deposit(s) in place (amount indicated above) (IMPORTANT: PLEASE ATTACH A VOIDED CHECK) This authority is to remain in full force and effect during my employment with the City of Puyallup. I understand that thirty (30) days notice, in writing, to the City is required if I change banks and/or accounts. SIGNATURE: DATE: INSTRUCTIONS FOR COMPLETING THE FORM EMPLOYEE NAME: As it appears on the City of Puyallup records. EMPLOYEE ID NUMBER: The employee ID number assigned by the City of Puyallup that appears on your payroll check stub. ACCOUNT NAME: The name (or names in the case of joint bank accounts) as they appear on your bank account. BANK NAME AND BRANCH: The name of your bank and branch. CITY, STATE AND ZIP CODE: of your branch. BANK TRANSIT ABA This is the 9 digit number on the bottom left of your checks. ACCOUNT NUMBER: This is your bank account number. It appears at the bottom of your checks. Please enclose a voided check for checking accounts and/or deposit slip for savings accounts for verification purposes. SIGNATURE AND DATE: Please sign and date the form. SIGN