Fillable City of Virginia Beach Finance Payroll Division Employee (City of Virginia Beach)

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City of Virginia Beach Finance Payroll Division Employee (City of Virginia Beach)

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City of Virginia Beach
Finance Payroll Division
Employee Direct Deposit Authorization
Revised: 06/28/12
Instructions
▪ For each checking account(s) attach a voided check or photocopy of voided check
▪ For each savings account(s) attach bank documentation for verification of bank routing and account number(s)
▪ A deposit slip is not acceptable documentation
▪ Provide at least two (2) weeks notice to the Finance Payroll Division prior to changing or closing any account(s)
▪ For one account, complete Section 1 ONLY. For two accounts, complete Section 1 and 2. For 3 accounts, complete
Section 1, 2 and 3. Return completed form to the Finance Payroll Division. (Maximum of three accounts.)
Voter Registration & Elections
Employee Name: (Last First MI)
Employee Number
Organization
SECTION 1) Deposit Net Pay
Effective Date
1/1/2021
Checking Savings
Name of Financial Institution
Account Type (Select one)
Routing Number
Account Number
SECTION 2) Deposit Fixed Amount
$
Effective Date
Checking Savings
Name of Financial Institution
Account Type (Select one)
Routing Number
Account Number
SECTION 3) Deposit Fixed Amount
$
Effective Date
Checking Savings
Name of Financial Institution
Account Type (Select one)
Routing Number
Account Number
I authorize the City and Financial Institution(s) listed above to deposit automatically to the indicated account(s) all
amounts payable to me by the City. If funds to which I am not entitled are deposited into my account(s), I authorize the
City to direct the Financial Institution to return said funds. This authority shall remain in effect until canceled in writing.
Employee Signature
Date
Daytime Phone Number
For Finance Payroll Office Use Only:
System Input:
Date:
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City of Virginia Beach Finance Payroll Division Employee (City of Virginia Beach)

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Completed 4 June 2021

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