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Payroll Authorization For Direct Deposit
Into Employee's Account/ Accounts TREASURER AND RECEIVER GENERAL SHANNON P. O'BRIEN |
SECTION 1: Employee Information
Employee Name:_____________________ Department ID: ____________________
Employee ID: ________________
SECTION 2: Direct Deposit Information (Fill in as necessary)
Instructions: Direct deposits are distributed to accounts in order of the priority
starting with priority '1'. Designate one (and only one) account to receive
any excess funds left over after all direct deposits are processed. The total
of the percentages can not exceed 100%.
| Priority | Amount | Percent | Excess? | *Transit # | Account # | Checking/Savings |
| 1 | $ |
%
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| 2 | $ |
%
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| 3 | $ |
%
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| 4 | $ |
%
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| 5 | $ |
%
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| 6 | $ |
%
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| 7 | $ |
%
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| 8 | $ |
%
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| 9 | $ |
%
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| 10 | $ |
%
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*NOTE: To find the Transit Number, look at the bottom of your personal
check on the left side. You will find the nine-digit transit number there. Attach
a voided check from your checkbook if the direct deposit is for a checking account.
If it is a savings account, contact your bank/ credit union for help.
SECTION 3: Sign and Return to your payroll Supervisor
I hereby authorize my employer, through the State Treasurer, to deposit my net
pay and/or deductions to the financial institution/ institutions listed above.
My employer, through the State Treasurer, is also authorized to debit any over
deposit or error, which it has caused to be made to my account. The State Treasurer
or the employee may cancel this authorization anytime with proper notice to
the Payroll Supervisor.
Employee Signature: __________________________ Date___________________
Employee Work Phone number __________________