Full Text
CITY OF PUYALLUP DIRECT DEPOSIT AUTHORIZATION AGREEMENT EMPLOYEE NAME: EMPLOYEE ID: I hereby authorize the City of Puyallup to make payroll deposits to my bank account indicated below. NAME ON ACCOUNT: BANK NAME: CHECK APPLICABLE BOX AND INDICATE AMOUNT PER PAY PERIOD (IF LEFT BLANK = 100% OF NET PAY) CHECKING BANK ROUTING/TRANSIT ABA SAVINGS ACCOUNT NUMBER: ATTACH VOIDED CHECK OR BANK ACCOUNT VERIFICATION FORM 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: Keep existing account open while testing the new account, or Give me a cashable check while testing the new account This is in addition to current direct deposit(s) in place (amount indicated above) This authority is to remain in full force and effect during my employment with the City of Puyallup. I understand that the City will send a test file and my direct deposit may take up to 30 days to go into effect. I understand that I am to give at least ten (10) days notice if there is a direct deposit change, cancellation, or account change. SIGNATURE: DATE: INSTRUCTIONS FOR COMPLETING THE FORM EMPLOYEE NAME: Legal name as it appears on the City of Puyallup records. EMPLOYEE ID NUMBER: 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: The name of your bank. CHECKING or SAVINGS: Select bank or savings account type and amount of net pay to go into account(s). 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. SIGNATURE AND DATE: Sign and date the form. Enclose a voided check or bank account verification form for verification purposes. SIGN