AUTHORIZATION AGREEMENT FOR DIRECT DEPOSIT
1. INSTITUTUION: RSCC ___
2. Social Security Number:
TTCC____
TTCH____
TTCJ____
TTCO____
___ ___ ___ - ___ ___ - ___ ___ ___ ___
3. Employee Name: _____________________________________________
4. Transaction Code: ______ (A=Add C=Change D=Delete)
5. Account Type:
CHECKING _____
SAVINGS _____
6. Name of Financial Institution: ________________________________________________________
7. CALL FINANCIAL INSTITUTUION TO VERIFY TRANSIT ROUTING (8) AND ACCOUNT
NUMBER (9) INFORMATION
8. Transit Routing Number:
|: __ __ __ __ __ __ __ __ __ |:
9. Account Number:
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
I hereby authorize Roane State Community College to deposit my net pay automatically to the account at the financial
institution indicated above. I understand this agreement may be terminated by me at any time upon proper execution
of another authorized agreement.
Employee Signature
Original – Payroll Office
PA-004 Revised 4/99
__________________
Date