Fillable City of La Porte Direct Deposit Authorization (City of La Porte)

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City of La Porte Direct Deposit Authorization (City of La Porte)

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The City of La Porte Direct Deposit Authorization (City of La Porte) form is 1 page long and contains:

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  • 29 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of La Porte

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City of La Porte
Direct Deposit Authorization
Employee Name: _________________________________________________ Employee # ___________
Signature: _______________________________________________________ Date: ________________
This form authorizes the City of La Porte to send credit entries (and appropriate debit and adjustment entries),
electronically to my account indicated below. This authorizes the financial institution holding the account to
post all such entries.
I authorize the City of La Porte to INITIATE credit entries to the following accounts:
I authorize CHANGES to be made to indicated accounts:
Please CANCEL my direct deposit authorization on indicated account(s):
Net Payroll Direct Deposit (100%)
Financial Institution Name
aDRE
Transit Routing Number
Account Number
Checking or
Dollar Amount
Address, City, State
Savings
or Percentage
Additional Payroll Deductions
Financial Institution Name
aDRE
Checking or
Dollar Amount
Address, City, State
Transit Routing Number
Account Number
Savings
or Percentage
A voided check may be required for each account number listed
Due to banking requirements it may take up to two pay periods for direct deposit to be active
For Human Resources Use Only:
Prenoted: ___________________________ Processed By: ____________________________________
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City of La Porte Direct Deposit Authorization (City of La Porte)

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Completed 18 February 2021

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