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Pacific Service Employees Credit Union document sample
Document Sample
61-0567
DIRECT DEPOSIT AUTHORIZATION FORM (10/2009)
INSTRUCTIONS: Employees are encouraged to enroll in the direct deposit program through PGE@Work for
Me. Under the About Me, select Payment Method and follow the instructions. For those without Portal access,
complete the form below and forward it to the Payroll Department.
PERSONAL INFORMATION
PAYROLL EMPLOYEE (Last, First) FUTURE USE
Monthly LTD (Mthly) Yes
Biweekly Pension No
PERSONNEL NUMBER ADDRESS LANID
MAIN BANK DIRECT DEPOSIT (Required)
Add Checking Savings*
Change NAME OF FINANCIAL INSTITUTION ROUTING NO. ACCOUNT NO.
Cancel Pacific Service Credit Union 121181743
ADDITIONAL DIRECT DEPOSIT 1
Add Checking Savings* New Amount $ Old Amount $
Change NAME OF FINANCIAL INSTITUTION ROUTING NO. ACCOUNT NO.
Cancel
ADDITIONAL DIRECT DEPOSIT 2
Add Checking Savings* New Amount $ Old Amount $
Change NAME OF FINANCIAL INSTITUTION ROUTING NO. ACCOUNT NO.
Cancel
IN-LIEU MEALS
Add Checking Savings* New Amount $ Old Amount $
Change NAME OF FINANCIAL INSTITUTION ROUTING NO. ACCOUNT NO.
Cancel
Statement of Authorization:
I hereby authorize my employer to deposit all of my earnings (net of legitimate deductions and authorized withholdings) directly in my account in the
financial institution indicated above. I also authorize my employer to make subtractions from or additions to any earnings deposits as are necessary to
correct previous deposits subsequently found to be in error. In addition, I authorize the above-named financial institution to receive such earnings
deposits for credits to any account specified. This authorization shall remain in effect until one or both of the following occur: (i) Termination of my
employment or (ii) Giving my employer’s payroll department timely (two weeks in advance) written notice of any bank account changes or withdrawal
from the program. I understand that my employer or the above-named financial institution may, at their discretion, discontinue the direct deposit of my
earnings at any time. I understand my employer will process my Direct Deposit form upon receipt and that my employer cannot “hold” this request until
some future date. I understand that it may take three pay periods to implement this request. I also understand I will not be entitled to any form of
compensation should the deposit to my account be either early or delayed.
Employee / Pensioner Signature Date LAN ID Company / Home Phone Number
* Savings accounts require signed letter from Attach a Voided Check Payroll Department
your institution showing the bank name, Send Original, Completed Document to: Direct Deposit, Mail Code B6B
your name, account number and routing 77 Beale Street, San Francisco, CA 94105
number. fax to: (415) 973-5584
email: transactions@pge.com
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Rec’d Entered Entered By
61-0567
DIRECT DEPOSIT AUTHORIZATION FORM (10/2009)
INTRODUCTION
The Payroll Direct Deposit program is available to all PG&E employees. To enroll in the program, complete the
Payroll Main Bank Direct Deposit Authorization form which is available on the Payroll Web Site. (Note: for
Accounts Payable Direct Deposit, call the PAID line, 8-223-7243.) This authorizes your employer to deposit the
net of your earnings into a specific account in the financial institution you designate.
In addition to the Main Bank Direct Deposit you may have up to two additional Direct Deposits, which convey
specific sums to the designated institution. You may have a third providing you are eligible for In Lieu Meals. You
must have a Main Bank Direct Deposit before you may use Additional Direct Deposits.
PAYROLL MAIN BANK DIRECT DEPOSIT INSTRUCTIONS
TO ENROLL
Complete the form and remember to:
1. Check the action, “New”.
2. Check one account type (either checking or savings).
3. Sign the form.
4. Staple a voided check (showing your pre-printed name and bank routing and account numbers) or
other appropriate documents for savings accounts to the form and mail to the Payroll Department.
5. Mail or fax the form to the Payroll Department.
TO CHANGE YOUR BANK ACCOUNT
Complete the form and remember to:
1. Check the action, “Change”.
2. Check one account type (either checking or savings).
3. Sign the form.
4. Staple a voided check (showing your pre-printed name and bank routing and account numbers) or
other appropriate documents for savings accounts to the form and mail to the Payroll Department
5. Mail or fax the form to the Payroll Department.
TO WITHDRAW
Complete the form and remember to:
1. Check the action, “Cancel”.
2. Sign the form.
3. Mail or fax the form to the Payroll Department.
NOTE THAT THIS ACTION CANCELS ALL DIRECT DEPOSITS YOU MAY HAVE REQUESTED.
TO ADD AN ADDITIONAL DIRECT DEPOSIT:
Complete the sections for Additional Direct Deposits and remember to:
1. Check one account type (either checking or savings).
2. For a checking account, staple a voided check (it must show your pre-printed name, and the bank
routing and account numbers) to the form and mail to the payroll department. Do not substitute a
deposit slip. Doing so will result in this request being returned to you and implementation of your
request being delayed.
3. For other account types, staple a letter or other document from the institution which shows your
name and the bank routing and account numbers.
4. Sign the form.
5. Mail or fax the form to the Payroll Department.
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61-0567
DIRECT DEPOSIT AUTHORIZATION FORM (10/2009)
TO CHANGE THE ACCOUNT NUMBER OR AMOUNT OF AN EXISTING ADDITIONAL DIRECT DEPOSIT
Complete the form and remember to:
1. Check the action, “Change”.
2. Check one account type (checking or savings).
3. Indicate both the old and new account numbers and the old and new amounts that you wish to have
deposited in this account.
4. Sign the form.
5. For a checking account, staple a voided check (it must show your pre-printed name, and the bank
routing and account numbers) to the form and mail to the payroll department. Do not substitute a
deposit slip. Doing so will result in this request being returned to you and implementation of your
request being delayed.
6. For other account types, staple a letter or other document from the institution which shows your
name and the bank routing and account numbers.
7. Mail or fax the form to the Payroll Department
TO WITHDRAW AN ADDITIONAL DIRECT DEPOSIT
Complete the form and remember to:
1. Check the action, “Cancel”
2. Check the account type you wish to cancel.
3. Indicate the account number and payment amount that you wish to cancel.
4. Sign the form.
5. Mail or fax the form to the Payroll Department.
NOTE THAT CANCELING YOUR ADDITIONAL DIRECT DEPOSITS WILL NOT CANCEL YOUR MAIN BANK DIRECT
DEPOSIT REQUEST. HOWEVER, CANCELING YOUR MAIN BANK WILL CANCEL ALL ADDITIONAL DIRECT
DEPOSITS. To have a direct deposit you must have a main bank.
MAIL DIRECT DEPOSIT AUTHORIZATION FORMS TO:
Payroll Department
Direct Deposit, Mail Code B6B
77 Beale Street, San Francisco, CA 94105
fax to: (415) 973-5584
email: transactions@pge.com
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