Direct Deposit

Enter first 9 digits found at bottom left of a personal check:

Choose your account type:

Put your Checking/Savings Account Number:

Financial Institution:

Choose one you wish to deposit:

• % of net pay = A percentage of your net pay amount will be deposited into your account.(Ex. 5% of a $100.00 check=$5.00 being deposited in your account).

• Specific Dollar amount = A specific dollar amount you choose will be deposited into your account.

• Note: if either of these options is chosen, the remainder of your net pay amount will be given to you and as a paper check.

If you choose "Full Net Pay Amount" you don't need to enter an amount

Additional note:

I authorize my employer/company to deposit my earnings into the bank account(s) specified above and, if necessary, to electronically debit my account to correct erroneous entries. I certify my account(s) allow these transactions. Furthermore, I certify that the above listed account number accurately reflects my intended receiving account. I agree that direct deposit transactions I authorize comply with all applicable laws. My signature below indicates that I am agreeing that I am either the accountholder or have the authority of the accountholder to authorize my employer/company to make direct deposits into the named account.

Employee/Worker Signature