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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