Direct Deposit Form-7::2,M coTq X)lMXM40sSrT sss
Your Pav Goes into the Bank. You Don't Direct Deposit Is ..............
Convenient! Safe! Confidential! Reliable! Best ojall. ._.It's FREEM
Simply fill out the information requested below, and return it to the Human Resources department.
o hereby authorize the City of Smyrna to deposit any amounts owed me by initiating credit entries to my accounts at the financial institutions (hereinafter "Bank") indicated
i n this form. Further. I authorise Bank to accept and to credit any credit entries indicated by the City to my accounts. In the event that the City deposits funds erroneously
into my account, I authorize the City to to
my account for an amount not to exceed the original amount of the erroneous credit.
This authorization is to remain in full force and effect until the City of Smyrna and Bank have received written notice from me of its termination in such time and in such
manner as to afford the City and Bank reasonable opportunity to act on it.
Employee Name
Employee # Signature
ACCOUNT INFORMATION
Check as applicable: ❑ Begin Direct sit
�Po El Cancel Direct Deposit
You may choose up to three accounts — your last account must be for the remaining amount owed to you.
A.
Bank Name Routing Number &Account Number
1 wish to deposit: $
or Entire Amount
Bank Name
1 wish to deposit:
A
or Entire Amount
Routing Number & Account Number
Bank Name Routing Number & Account Number
I wish to deposit: $ or Entire Amount
Attach a voided check for each checking account and/or a deposit slip for each savings account designated above.
Entered by HR:
Date: Prenote: n Yes
Date
❑ Change Information
Checking O Savings O
Checking O Savings O
Checking O Savings O
No