New York City Department of Education
CANCELLATION
TYPE OF ACTION / ATTACH A CANCELLED CHECK OR MOST RECENT SAVINGS STATEMENT
ELECTRONIC FUND TRANSFER APPLICATION
CHANGE OF : (Check All That Are Affected)
PERSON(S)
ACCOUNT
ACCOUNT
ABA*
***** PLEASE PRINT CLEARLY IN CAPS WITH BLACK INK PEN *****
EMPLOYEE INSTRUCTIONS: COMPLETE THE EMPLOYEE INFORMATION, AND ACCOUNT INFORMATION SECTIONS
EMPLOYEE NAME
WORK TELEPHONE NO.
LASTFIRSTM.I.
SOCIAL SECURITY NUMBER
PAYROLL BANK NO.
PERSON(S) NAME ON ACCOUNT (PRINT EXACTLY - INCLUDE TRUSTEE OR JOINT OWNER).
- FOR 'CHANGE' APPLICATIONS, PRINT THE NEW ACCOUNT INFORMATION.
- FOR 'CANCELLATIONS', LEAVE BLANK AND SIGN CANCELLATION AUTHORIZATION.
ABA NUMBER* ACCOUNT NUMBER ** ACCOUNT TYPE
** SEE CHECK, PASSBOOK OR ACCOUNT STATEMENT FOR ACCOUNT NUMBER.
SAVINGS CHECKING
* ABA BANK NUMBER
CHECKING ACCOUNTS -- THE ABA NUMBER IS THE FIRST NINE (9) NUMBERS PRIOR TO THE ACCOUNT NUMBER IN THE BOTTOM LEFT CORNER OF CHECK
SAVINGS ACCOUNT -- CONTACT YOUR BANK FOR ABA NUMBER, IF UNKNOWN.
NOTE:
PLEASE CONFIRM WITH YOUR FINANCIAL INSTITUTION THAT THE ABA NUMBER AND ACCOUNT TYPE ARE CORRECT FOR DIRECT DEPOSIT. FOR MONEY MARKET ACCOUNTS, PLEASE VERIFY
WITH YOUR FINANCIAL INSTITUTION THE APPROPRIATE ACCOUNT TYPE FOR DIRECT DEPOSIT.
EMPLOYEE AUTHORIZATION FOR NEW OR CHANGE APPLICATIONS
I HEREBY AUTHORIZE THE CITY OF NEW YORK TO DEPOSIT MY NET PAY DIRECTLY INTO MY CHECKING OR SAVINGS ACCOUNT AS
REQUESTED. I ALSO GRANT AUTHORIZATION FOR THE REVERSAL OF A CREDIT TO MY ACCOUNT IN THE EVENT THAT A CREDIT
WAS MADE IN ERROR. I UNDERSTAND THAT, UNDER THE “NATIONAL AUTOMATED CLEARING HOUSE ASSOCIATION” OPERATING
GUIDELINES AND RULES, THE CITY OF NEW YORK CAN ONLY REVERSE THE AMOUNT OF THE INCORRECT DIRECT DEPOSIT. I
AGREE THAT THIS AUTHORIZATION WILL REMAIN IN EFFECT UNTIL I PROVIDE TO MY AGENCY A WRITTEN CANCELLATION TO
TERMINATE THE SERVICE.
CANCELLATION AUTHORIZATION
I HEREBY AUTHORIZED THE CITY OF NEW YORK TO CANCEL MY DIRECT DEPOSIT AUTHORIZATION AGREEMENT.
SIGNATURE: DATE:
ENTERED BY: DATE:
LAST NAME
2)
FIRST NAME M.I.
LAST NAME
1)
FIRST NAME M.I.
740 ADMINISTRATIVE
745 SCHOOL BASED
HOURLY SUPPORT
746 PER DIEM TEACHERS 747 PER SESSION
TEACHERS
(PLEASE CHECK ONE, IF NOT THE FORM WILL BE RETURNED)
***** PLEASE ENTER INFORMATION, PRINTOUT THE FORM & SIGN UPON COMPLETION *****
ELECTRONIC FUND TRANSFER APPLICATION
PLEASE CONFIRM WITH YOUR FINANCIAL INSTITUTION THAT THE ABA NUMBER AND ACCOUNT TYPE ARE CORRECT FOR DIRECT DEPOSIT.
FOR MONEY MARKET ACCOUNTS, PLEASE VERIFY WITH YOUR FINANCIAL INSTITUTION THE APPROPRIATE ACCOUNT TYPE FOR DIRECT DEPOSIT.
- If ‘YES’ is selected a pay stub will be printed. If ‘NO’ or left blank, you will NOT receive a pay stub.
