AUTHORIZATION AGREEMENT FOR DIRECT DEPOSITS
First Last MI
Address
City State Zip Code
E-Mail Address (for electronic pay stub):_____________________________________________________________________
I hereby authorize Stockbridge-Munsee Community (SMC) and my bank to automatically make deposits into my
account listed above (this includes my authorization to correct entries made in error.) This authorization
will remain in effect until I give written notice to cancel it.
Bank Account
Checking Savings
Circle Type of Account
Account Number
No more lost or misplaced checks.
Bank Name * Your check's automatically deposited into your account
Bank Routing # * It eliminates a trip to the bank.
**
For account verification, you must attach a voided check.
If your bank account number has changed, you must provide a voided check or bank specification sheet.
Banks are very strict with their routing number to avoid any issues, please attached requested documentation.
The processing of this form will take at least
Signature Date
Processed by Date
Stockbridge-Munsee Community
Office of Accounting Services
Account Payables
Customer
Name
Complete for DIRECT DEPOSIT
FOR ACCOUNTING SERVICES USE ONLY
click to sign
signature
click to edit
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