Direct Deposit
Please print
Name (Last, First, Middle Initial)
Effective Date
Department Telephone Number
Social Security Number
Please note: Form MUST be received fifteen (15) days prior to Pay Date. Once processed, direct deposits will be immediately posted
to your account. If modifying an existing agreement, please IMMEDIATELY notify the District Payroll Office if you have CLOSED your
account at your financial bank/institution to avoid processing delays.
Instructions: The following instructions refer to the corresponding sections below, numbered one through four of the direct deposit
agreement. If terminating the existing agreement, only complete sections one through three below.
1. Check the appropriate box to indicate checking or savings account and if terminating the account.
2. Complete the bank or financial institution name, routing number, account number, address, city, state, and zip code.
3. Date and sign the agreement.
4. YOU MUST attach a current voided check or bank/institution confirmation form below, or this request cannot be processed.
5. Only one direct deposit agreement and account can be active at any time.
Authorization Agreement For Automatic Direct Deposits
I hereby authorize the West Kern Community College District to initiate credits and/or debits at the bank/institution indicated below
and authorize bank/institution to credit and/or debit the amounts thereof to my account indicated below and remain active until
notified by me (the employee) in writing and/or at the discretion of the West Kern Community College District.
1
Please Check Appropriate Box Checking Savings Terminate
2
Name of Bank/Institution
Address
Routing Number
City
Account Number
State
1
Please Check Appropriate Box Checking Savings Terminate
2
Name of Bank/Institution
Address
Routing Number
City
Account Number
State
Zip Code
3
Employee’s Signature
Date
4
Staple voided check or Bank/Institution confirmation form with pre-printed transit/routing number and account
number to this request.
To Bank: As provided above, your depositor has authorized the West Kern Community College District (WKCCD) to initiate credits/debits to your
bank/institution and the designated bank/institution to credit/debit his/her account as specified. So that you may comply with this authorization, WKCCD
agrees that these arrangements shall be subject to the current Automated Clearing House rules. WKCCD recognizes the status of the participating
bank/institution.
West Kern Community College District
29 Cougar Court, Taft, CA 93268
(661) 763-7900
New Agreement
Change to Existing Agreement
Comments:
Comments:
click to sign
signature
click to edit
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