Fillable CUESTA COLLEGE Payroll Direct Deposit Authorization Agreement general payroll

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CUESTA COLLEGE Payroll Direct Deposit Authorization Agreement general payroll

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Payroll Direct Deposit
Authorization Agreement
P. O. Box 8106, San Luis Obispo, CA 93406
San Luis Obispo County Community College District No. 22
Employee Name:
Account Type – Select One: Checking
Banner ID:
Savings
I hereby authorize my employing district through San Luis Obispo County Community College and the financial institution
shown on the check below, to deposit my net pay into my account. I shall hold harmless and indemnify the San Luis Obispo County
Community College, herein after referred to as Cuesta College, and its officers and employees from any claim or demand of
whatever nature including those based upon negligence of Superintendent and its officers and employees, brought by any person,
including any banking institution against the College in his/her capacity concerning the Payroll Warrant disposition provided by the
Superintendent.
I also agree to pay all fees incurred because of failure on my part to notify Cuesta College of any changes in my account
information that would result in a return of my deposit.
I understand it is my responsibility to ensure that my net check has been properly credited to my account before issuing
checks against that account. If funds to which I am not entitled are deposited, I hereby authorize Cuesta College either to direct the
financial institutions to return such funds or to request a “stop payment” of the Auto Deposit and to issue a warrant for the correct
amount. Electronic fund transfer takes effect on the next payroll following request. This completed request is for the disposition of
pay warrant from the effective date specified until I have signed the cancellation section below.
Date Employee Signature
Cancellation
Do NOT complete this portion unless you are Canceling your Direct Deposit
I h
ereby request that Cuesta College discontinue direct deposits to the account number above, effective the next pay
period after receipt of the request.
Date Employee Signature
DEPOSITS TO CHECKING ACCOUNTS
Attach a Voided Preprinted Check – Deposit Slips are NOT acceptable
DEPOSITS TO SAVINGS ACCOUNTS
Attach a Preprinted Form from Your Bank
THIS
FORM MUST BE TURNED IN TO THE PAYROLL OFFICE –
ELECTRONIC DELIVERY IS NOT ACCEPTABLE
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CUESTA COLLEGE Payroll Direct Deposit Authorization Agreement general payroll

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Completed 20 January 2020

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