AUTHORIZATION FOR DIRECT DEPOSIT
[ ] Initial Request
[ ] Change
[ ] Savings
[ ] Checking
Name ____________________________________________
__________________________________________________
Work Location ___________________________________
__________________________________________________
Job Title _________________________________________
Phone Number____________________________________
Last
First
Social Security Number
I authorized my employer Paterson Public Schools and the bank indicated below to direct deposit my net pay automatically to my account each payday. If
monies to which I am not entitled are deposited in my account, I authorize my employer to direct the bank and return said funds. This authority will remain in effect
until I have cancelled it in writing.
Must obtain the correct Transit Routing Number and Account Number from your bank and complete the form below. It is your responsibility to supply the correct
information required.
Employee Signature _____________________________________________ Date _______________________
PLEASE ATTACH A VOID CHECK or SAVINGS DEPOSIT SLIP
Reinstate your Bank Account: ____________
Bank Name ______________________________________ Transit Routing __________________________________
Branch Address _________________________________
City, State, Zip ___________________________________
Account # ________________________________________
District E-Mail Address__________________________________________________
(Direct Deposit Statements will be sent electronically)
ATTACH VOID CHECK HERE
FOR PAYROLL USE ONLY:
BANK ID ___________________________________
PRE-NOTE _________________________________
LIVE _______________________________________
Date Back to Active: _________________________
AUTDEP