Administrative Form PAY-F001
AUTHORIZATION AGREEMENT FOR DIRECT DEPOSIT
3/21/2012; Rev. A PAY-F001 Page 1 of 1
Responsible: Office Business and Financial Services, Payroll Department
Procedure:
1. Employees may add and change Direct Deposit information by using Employee Online at
https://www.washoeschools.net/Domain/266
.
2. All forms are to be turned in to the Payroll Department by the last day in a pay period for
changes to effect for that pay date.
3. Employees are allowed to have funds deposited into a maximum of two (2) accounts.
4. ATTACH A VOIDED CHECK FOR ALL CHECKING ACCOUNTS.
PRIMARY ACCOUNT (select one): _____ Checking _____ Savings
% of pay to this account: ___________% OR flat amount to this account: ____________
Name of Bank or Credit Union:
_____________________________________________________________________________
Transit Routing Number Account Number Information
__________________________________ ___________________________________
SECONDARY ACCOUNT (select one): _____ Checking _____ Savings
% of pay to this account: ___________% OR flat amount to this account: ____________
Name of Bank or Credit Union:
_____________________________________________________________________________
Transit Routing Number Account Number Information
__________________________________ ___________________________________
Name: __________________________________ School/Dept: ________________________
Employee ID #: __________________________ Last 4 of SSN #: _____________________
_______________________________________ __________________________
Signature of Employee Date
I hereby authorize Washoe County School District (“WCSD”) to initiate, if necessary, debit
entries and adjustments for any credit entries in error to my account (accounts) indicated above and
the depository institution named above to credit and/or debit the same to such account.
This authority is to remain in full force and effect until WCSD has received written notification from
me of its termination in such time and such manner as to afford WCSD and Depository a reasonable
opportunity to act on it.
PAYROLL DEPARTMENT USE ONLY
Date Request Received: ____________________
Processed By: ____________________________
