Checking Savings. The authority is to remain in full force until The Diocese of Sioux City has received written notification of its termination in such timely manner as to afford the Diocese and the Financial Institution a reasonable opportunity to act on it. Signature: Printed Name: Date: Bookkeeper Contact Info: Bookkeeper Name: Email: Bookkeeper Phone: Fax: Please submit this form and a voided check (or photocopy of a check) to Xxxxxxx Xxxxxxx at xxxxxxxx@xxxxxxxxx.xxx or fax to: 000-000-0000 #N/A
Checking Savings. $ or Full Net Check or Full Net Check This authorization may be cancelled by me at any time.
Checking Savings. This authorization is to remain in full force and effect until COMPANY has received notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DFI a reasonable opportunity to act on it. Name(s) Signed Date Customer Telephone # Customer email address *DISTRICT USE ONLY – SERVICE ACCOUNT # Note: All written credit authorizations should provide that the receiver may revoke the authorization only by notifying the originator in the manner specified in the authorization.
Checking Savings. The frequency of the ACH Debit will be monthly occurring on the 20th of each month. Please note that if the 20th falls on a weekend or a Holiday, the Debit will occur the first business day after the 20th. This authority is to remain in full force and will be effective until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY a reasonable opportunity to act on it. I (we) can stop payment of any entry by notifying my (our) financial institution 3 business days before my (our) account is charged. I (we) understand it is my (our) responsibility to ensure that proper funding is available in my (our) account at the time the COMPANY initiates the ACH Debit. If proper funding is not available, I (we) will be charged the appropriate fees incurred by the COMPANY from the bank plus an administrative fee of $10.00 (ten) dollars. I (we) realize this agreement may be terminated by the COMPANY immediately if any debit is not honored by the Financial Institution named for any reason. (Name of Financial Institution) (Branch Address) (City) (State) (Zip) (Transit/ABA/Routing Number) (Bank Account Number) Making Payments for: (Name of CCP Retiree or Spouse) ATTENTION: The monthly deduction will appear on your bank statement with notation of “RetireeFirst.” ***** ATTACH A VOIDED CHECK ***** Please Print Name Social Security Number Street Address Telephone/Cell Number (City) (State) (Zip) SIGNATURE DATE
Checking Savings. This authority is to remain in full force and effect until the city of Xxxxxx has received written notice of its termination in such time and manner as to afford the City of Xxxxxx and Financial Institution a resonable opportunity to act on it. Signature Date
Checking Savings. This authority is to remain in full force and effect until POLICY RESEARCH ASSOCIATES, INC., has received written notification from me to terminate ACH/Direct Deposit. Individual or Organization Name Email Address to Receive Deposit Notification Social Security Number or Tax Identification Number Authorized Signer Date Title Joint Account Owner (if applicable) Signature Date Note: Please attach a voided blank check or savings account deposit slip (copies of blank checks and deposit tickets are acceptable) to validate account information.
Checking Savings. 1. 100% (check one) OR
Checking Savings. Amount $ If net check is to be deposited, leave amount blank Account Information Name of Financial Institution: Routing Number: Account Number: Checking Savings Amount $ Account Information Name of Financial Institution: Routing Number: Account Number: Checking Savings Amount $ Employee Signature and Information Employee Name: Employee # Authorized Signature: Date:
Checking Savings. E. Full Deposit Partial Deposit (Amt per payroll) Please return to the Payroll Department with a voided check from your checking account. For your savings account we need a form from your bank with Routing # and Account #. (NO DEPOSIT SLIPS) ***Your account # will be pre-noted the first two weeks. -I authorize Ball’s Foods and the bank listed above to deposit my net pay or portion thereof as indicated above into my account each payday. -If funds to which I am not entitled are deposited into my account, I authorize Ball’s Foods to direct the bank to return said funds. -I understand that my deposit may not be credited to my account until 5:00 PM on Friday (Refer to the paydate indicated on the check voucher).
Checking Savings. I hereby authorize the Trenton Board of Education to initiate by electronic means direct deposit (credit entries) of my net earnings to the accounts listed above and to initiate, if necessary, debit entries and adjustments for any credit entries in error. I authorize my bank to accept and to credit and/or debit the amount of such entries to my account. Employee Signature: Date: **Please see instructions on page 2. **Form must be signed by employee. **Direct deposit authorization form from your bank or a voided check must be provided. **Must indicate if deposit to checking or savings accounts. PLEASE RETURN FORM TO PAYROLL DEPARTMENT 1 0 8 N x x x x C x x x x x x A v e n u e • T r e n t o n, N x x X x x x x x 0 8 6 0 9 – 1 0 1 4 xxx.xxxxxxx.x00.xx.xx
