I authorize Danville Area Community College (DACC) and the financial institution listed below to initiate
Direct Deposit of Payroll credit entries and necessary debit entries for adjustments to my:
City:
Checking
Account
Savings
Account
Amount to
Deposit*
$
*Remaining
Amount
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
City:
Checking
Account
Savings
Account
Amount to
Deposit*
*Remaining
Amount
This authority is to remain in full force until DACC has received written notification from me to terminate this
authorization in such time as to allow DACC and the Financial Institution a reasonable opportunity to act on it.
Name: Colleague ID number
Signature: Date:
If available, please attach a voided check or deposit slip.
Note: The first payroll after signing up for direct deposit will be a test. Zero dollars will be sent to your
financial institution to make sure that the electronic process is correct.
Please return this form to the Controller in the Business Office for processing.
State:
Transit Routing Number
Account Number
(Select only one savings /
checking account per line)
(Select only one savings /
checking account per line)
AUTHORIZATION AGREEMENT FOR
DIRECT DEPOSIT OF PAYROLL
Financial Institution:
Transit Routing Number
Account Number
Financial Institution:
State:
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