Employee Authorization for Direct Deposit

Payroll & tax

Request

Page one of this form is the district's Direct Deposit Guidelines and Procedures. In short: payroll may not be split between direct deposit and a paper cheque (the one exception is an existing credit-union deduction); the first payroll after this authorization is a test run and you will still receive a regular cheque; a bank or account change puts you back on a regular cheque for one payroll; and participation can be stopped with two weeks' written notice to the Payroll Department.

This request is

Initial EnrollmentChangeCancellation

Print or type name

Social Security NumberRequired by Payroll to identify your record. If you would rather not enter it online, leave this blank and write it on the printed form before signing.

Date

Account

Your financial institution name

Checking or savings account number

Account type

Checking AccountSavings Account

Choose only one.

Address

City

State

Zip Code

Institution phone — area code

Institution phone — number

Authorization

I authorize the Harper Woods School District, the financial institution listed above and BANK ONE/MILAF to deposit my pay automatically to my checking or savings account each payday, and to make adjusting entries to correct errors. This authority remains in effect until I cancel it in writing.

I have read the Harper Woods School District's Guidelines and Procedures on direct deposit and agree to the terms and conditions.

Attach a voided check to the printed form. If a voided check is not attached, you must be sure to add the accurate and complete routing number, account number and account type. The signature line stays blank for you to sign by hand.