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City of Whitefish Human Resources Department 418 East Second Street / PO Box 158 Whitefish, MT 59937 (406) 863-2400 I Fax (406) 863-2419 Direct Deposit Authorization Form I hereby authorize the City of Whitefish to directly deposit my pay in the bank account(s) listed below in the percentages specified. (If two accounts are designated, deposits are to be made in whole percentages of pay to total 100%.) I have attached a voided personalized check (checking accounts) or deposit slip (savings accounts) for each account specified below. No more than two accounts may be designated. This authorization is to remain in force until the City has received written authorization from me of its termination or change. Also, I hereby grant the City of Whitefish the right to correct any such electronic funds transfer resulting from an erroneous overpayment by debiting my account to the extent of such overpayment. Name (PRINT): Date: Signature: Account #1 (Check only one) [ ] Checking (attached voided check) [ ] Savings (attach deposit slip and obtain ABA routing number from your bank) Financial Institution: Street Address: City, State and Zip Code: Telephone: ( ) Personal Account Number: ABA (Routing)Number: Amount of pay to be deposited into this account: % ---PAGE BREAK--- Page 2 of 2 Account #2 (Check only one) [ ] Checking (attached voided check) [ ] Savings (attach deposit slip and obtain ABA routing number from your bank) Financial Institution: Street Address: City, State and Zip Code: Telephone: ( ) Personal Account Number: ABA (Routing)Number: Amount of pay to be deposited into this account: %