Electronic Deposit Authorization AWS
BUTTE GOUNTY Of"FICEOF F.DUCATION .1859 Bird Street Q; ;:;;;i\:e, CA 9596'5
D j
D
NEW REQUEST
PA YROt;l.DEPARTMENT 530·5 32--,5 650 f,:1 x ~30-532·5779
ELECTRONIC DEPOSIT AUTHORIZATION'
NAME CHANGE
Effective Date:
NET CHECK AUTHORIZATION I Authorize the Butte County Office of Education and the financial institution listed below to deposit my NET pay automatically to the account indicated each payday and, if necessary, to adjust or reverse a deposit for any payroll entry made to my account in error
D
Checking
D ·Savings Account
D
D
Cancel
Transit Routing#
Change
Account# NET PAY
Financial Institution
I VOLUNTARY DEDUCTION (Separate Checking or Savings Account, Deposit Flat amount only) D
Checking
D
Savings Account
D
O
Cancel
Change
Transit Routing#
Account#
Financial Institution
Amount to Deposit
VOLUNTARY DEDUCTION (Separate Checkin or Savings Account, Deposit Flat amount only) Checking Savings Account Cancel Change
D
D
Transit Routing#
Account#
Financial Institution
Amount to Deposit
I VOLUNTARY DEDUCTION (Separate Checking or Savings Account, Deposit Flat amount only) D
Checking
D
Savings Account
O
O
Cancel
Change
Transit Routing#
Account#
Financial Institution
Amount to Deposit
VOLUNTARY DEDUCTION (Separate Checking or Savings Account, Deposit Flat amount only) Checking Savings Account Cancel Change
D
D
D
Transit Routing#
Account#
Financial Institution
Amount to Deposit
Transit Routing#
Account#
Financial Institution
Amountto Deposit
I VOLUNTARY DEDUCTION (Separate Checking or Savings Account, Deposit Flat amount only) D Checking D Savings Account O Cancel O Change
For checking accounts, please attach a voided check to this form. For savings accounts, please contact your financial institution for the proper transit routing number and account number. Any missing or incorrect information will cause these transactions to be delayed. I understand that my first payroll check after this authorization will be mailed to my current mailing address while a test payroll is sent to my financial institution. This authorization will remain in effect until I have canceled it in writing.
Name (Please Print)
Date
ID# (or Social Security)
Signature
HR 84: Electronic Deposit Authorization (Revised 10/12)
D j
D
NEW REQUEST
PA YROt;l.DEPARTMENT 530·5 32--,5 650 f,:1 x ~30-532·5779
ELECTRONIC DEPOSIT AUTHORIZATION'
NAME CHANGE
Effective Date:
NET CHECK AUTHORIZATION I Authorize the Butte County Office of Education and the financial institution listed below to deposit my NET pay automatically to the account indicated each payday and, if necessary, to adjust or reverse a deposit for any payroll entry made to my account in error
D
Checking
D ·Savings Account
D
D
Cancel
Transit Routing#
Change
Account# NET PAY
Financial Institution
I VOLUNTARY DEDUCTION (Separate Checking or Savings Account, Deposit Flat amount only) D
Checking
D
Savings Account
D
O
Cancel
Change
Transit Routing#
Account#
Financial Institution
Amount to Deposit
VOLUNTARY DEDUCTION (Separate Checkin or Savings Account, Deposit Flat amount only) Checking Savings Account Cancel Change
D
D
Transit Routing#
Account#
Financial Institution
Amount to Deposit
I VOLUNTARY DEDUCTION (Separate Checking or Savings Account, Deposit Flat amount only) D
Checking
D
Savings Account
O
O
Cancel
Change
Transit Routing#
Account#
Financial Institution
Amount to Deposit
VOLUNTARY DEDUCTION (Separate Checking or Savings Account, Deposit Flat amount only) Checking Savings Account Cancel Change
D
D
D
Transit Routing#
Account#
Financial Institution
Amount to Deposit
Transit Routing#
Account#
Financial Institution
Amountto Deposit
I VOLUNTARY DEDUCTION (Separate Checking or Savings Account, Deposit Flat amount only) D Checking D Savings Account O Cancel O Change
For checking accounts, please attach a voided check to this form. For savings accounts, please contact your financial institution for the proper transit routing number and account number. Any missing or incorrect information will cause these transactions to be delayed. I understand that my first payroll check after this authorization will be mailed to my current mailing address while a test payroll is sent to my financial institution. This authorization will remain in effect until I have canceled it in writing.
Name (Please Print)
Date
ID# (or Social Security)
Signature
HR 84: Electronic Deposit Authorization (Revised 10/12)
