HomeMy WebLinkAboutDIRECT DEPOSIT AUTHORIZTION AGREEMENT DIRECT DEPOSIT AUTHORIZATION AGREEMENT
I AUTHORIZE:
The City of Port Arthur, Texas and the Bank listed below to deposit my net pay check
automatically into my account each payday.
The City of Port Arthur to initiate any necessary debit entries to correct any error, provided
that any corrections not exceed the total of the original amount credited.
Authorization will remain in effect until the City of Port Arthur has received written notice
from me of its termination, and the City of Port Arthur has reasonable opportunity to act on it.
Employee Name (Please Print)
Social Security Number
Telephone Numbers: Work Home
Department/Division
Bank Name Branch
Location of Bank: State_TX Zip
*Primary Account Number Checking Savings
* Secondary Account Number Checking Savings
(If depositing to multiple accounts please indicate the amount or% to be deposited in the
secondary account and remainder will be deposited in primary account.)
Employee Signature Date
* Attach cancelled/voided check
Or Printed Deposit Slip
AUTHORIZATION TO DISCONTINUE AUTOMATIC DEPOSIT
I hereby request the City of Port Arthur to discontinue the automatic deposit of my payroll check.
Name Bank
Signature Date