CHABOT-LAS POSITAS COMMUNITY COLLEGE DISTRICT
Office of Payroll Services
DIRECT DEPOSIT FORM
Direct deposit requests must be verified first through a pre-note process with your financial institution to confirm
the account and routing numbers that were provided are numerically accurate. The pre-note process will occur
on the first payroll period in which you receive a paycheck. Once your account and routing numbers are verified,
your direct deposit will be effective the following payroll period.
If you choose to split your salary between more than one financial institution, your direct deposit distribution must
equal 100% of your net pay.
1.
Attach a voided check: If you do not have one, contact your financial institution for the following information:
Account #1
Financial Institution:
Amount or Balance $
(enter $ amount to be deposited or "Balance"
to indicate ALL or the remaining amount of your pay)
Routing number:
C
hecking
Account number: Savings
Account #2
Financial Institution:
Amount or Balance $
(enter $ amount to be deposited or "Balance"
to indicate ALL or remaining amount of your pay)
Routing number:
Checking
Account number: Savings
Account #3
Financial Institution: Amount or Balance $
(enter $ amount to be deposited or "Balance"
to indicate ALL or remaining amount of your pay)
Routing number:
Checking
Account number: Savings
2.
A voucher of your salary warrant will be emailed to you.
PLEASE PROVIDE YOUR OUTLOOK OR ZONE EMAIL ADDRESS BELOW
3.
SIGN BELOW and return this form to:
District Office, Payroll, 7600 Dublin Boulevard, 3rd Floor Dublin CA 94568
Print Name SSN / W #
Position Title Division/Office/Area Assigned
Signature
Date
Outlook or Zone Email Address
Posted by payroll:
Revised 08/05/2016 (S:Forms:Payroll/direct deposit form updated)
