HomeMy WebLinkAboutDirect Dep Form REV 012018CITY OF SARATOGA
AUTHORIZATION FOR PAYROLL DIRECT DEPOSITS
NAME _____________________________________ DEPARTMENT ______________________________
SIGNATURE ________________________________ DATE ______________________________________
I hereby authorize the City of Saratoga, hereinafter called CITY, to initiate credit entries and to initiate, if necessary,
debit entries and adjustments for any credit entries in error to the account(s) listed below and the depository (ies) named below, hereinafter called DEPOSITORY, to credit and/or debit the same to such account(s).
DEPOSITORY, to credit and/or debit the same to such account(s).
This Authorization is to remain in full force and effect until CITY has received written notification from employee of its termination in such time and in such manner as to afford CITY and DEPOSITORY (IES) a reasonable
opportunity to act on it.
Instructions and Information:
1. Please verify the routing number/ABA number with your bank. Allow at least one full payroll cycle to occur before direct deposit is in effect.
2. If you are listing two or more banks, list the bank accounts with an amount or percentage first. For the last
Depository listed indicate 100% in the percentage field (100% net of the remaining amount).
3. Please notify payroll as soon as possible if you are planning to close or have closed a bank account listed on the current authorization form so funds will not be transferred to an inactive account. The completion of a new
Authorization for Payroll Direct Deposits will be required with the most current bank information.
Depository 1:
Amount $ __________ OR Percentage _____%
ABA # (Routing #) _________________________
Account #_________________________________
Bank Name________________________________
Branch Name______________________________
City/State/Zip______________________________
Type of Account: Checking Savings
Depository 2:
Amount $ __________ OR Percentage _____%
ABA # (Routing #) _________________________
Account #_________________________________
Bank Name________________________________
Branch Name______________________________
City/State/Zip______________________________
Type of Account: Checking Savings
Depository 3:
Amount $ __________ OR Percentage _____% ABA # (Routing #) _________________________
Account #_________________________________
Bank Name________________________________
Branch Name______________________________
City/State/Zip______________________________
Type of Account: Checking Savings
Depository 4:
Amount $ __________ OR Percentage _____%
ABA # (Routing #) _________________________
Account #_________________________________
Bank Name________________________________
Branch Name______________________________
City/State/Zip______________________________
Type of Account: Checking Savings
Depository 5:
Amount $ __________ OR Percentage _____%
ABA # (Routing #) _________________________
Account #_________________________________
Bank Name________________________________
Branch Name______________________________
City/State/Zip______________________________
Type of Account: Checking Savings
NOV2017