AUTHORIZATION AGREEMENT
for Electronic Deposits
Name: ____________________________________ Social Security Number: xxx-xx- _______
Employee Number: ______________________
BANK NAME
CITY OF BANK
BRANCH
DEPOSIT TO:
CHECKING SAVINGS
BANK ROUTING
NUMBER
ACCOUNT NUMBER AMOUNT
Notes:
Bank Routing Number is the first group of numbers at the bottom of check.
If depositing funds to more than one account, please indicate amount to be deposited to first
account and indicate “remainder” to be deposited to second account.
I authorize Durham Technical Community College to deposit my net pay to the bank and account
indicated above.
Signature: _________________________________________________ Date: __________________
Attach voided check or account verification from bank to this form.
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signature
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