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DEPOSIT SLIP form

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DEPOSIT SLIP form Powered By Docstoc
					                     Authorization Agreement for Direct Deposit (ACH Credits)


Employee’s Name:                                                       Colleague ID # ______________
                                  (Please print)

Home Phone Number:         ___ __                            Office:        _____________________


Due to our effort to ensure accuracy in establishing your direct deposit account, your next payment
after submitting this form will be done by check. The following will be a direct deposit.

You will not receive a printed pay advice. Advices can be viewed and printed on Webadvisor.

   1. ( ) Savings Account or ( ) Checking Account        Account # __________________________
           Routing # ______________________              Bank Name _________________________
          ( ) $ __________ amount to deposit or
          ( ) Entire amount of check


   2. ( ) Savings Account or ( ) Checking Account        Account # __________________________
          Routing # ______________________               Bank Name __________________________
          ( ) $ __________ amount to deposit or
          ( ) Remainder of Check


   3. ( ) Savings Account or ( ) Checking Account        Account # ___________________________
          Routing # ______________________               Bank Name _________________________
          ( ) $ __________ amount to deposit or
          ( ) Remainder of Check

_______________________________________                      ________________________________
Employee Signature                                           Date signed


            You must attach a copy of a voided check to this form to activate this service.
                                We cannot accept deposit slips.




                                                                                  Revised February 26, 2010

				
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