DIRECT DEPOSIT AUTHORIZATION FORM
I hereby authorize the City of Hickory and the financial institution(s) shown to deposit my pay
directly to my account each payday. If funds to which I am not entitled are deposited to my account,
I authorize the City of Hickory to direct the bank to return said funds. This authority will remain in
effect until I file a new Authorization Form or cancel my participation. I understand that deposited
funds will generally be available on the morning of our regular payday; however, ii is my
responsibility to verify the actual deposit of funds.
Check one: New
Change
Cancel
Name (please print):
Social Security Number:
Please fill in your bank account information below. For each account, please indicate whether it is a
checking account or a savings account.
Bank Name:
Address:
Transit/Routing#:
Account#
Checking: Savings: Amount/Percentage: $
Bank Name:
Address:
Transit/Routing#:
Account#
Checking
Savings
Amount$
Bank Name:
Address:
Transit/Routing#:
Account#
Checking
:
Savings
:
Amount$
IMPORTANT: Attach a voided check or savings account information so that we can obtain an
accurate routing and transit number for your financial institution.
Signature:
Date:
05/13/2019
