I hereby authorize the City of Fitchburg to initiate automatic deposits to my account at the financial institution
named below. I also authorize the City of Fitchburg to make withdrawals from this account in the event you
were overpaid incorrectly.
Further, I agree not to hold the City of Fitchburg responsible for any delay or loss of funds due to incorrect or
incomplete information supplied by me or by my financial institution or due to an error on the part of my financial
institution in depositing funds to my account.
This agreement will remain in effect until the City of Fitchburg receives a written notice of cancellation from me
or my financial institution for just cause, or until I submit a new direct deposit form to the Payroll Department. Any
such information shall be effective only with respect to entries initiated by the City of Fitchburg after receipt of
such notification and a reasonable opportunity to act. ANY SUCH NOTIFICATION TO THE FINANCIAL
INSTITUTION BY THE EMPLOYEE IS UNACCEPTABLE.