SAN BERNARDINO COMMUNITY COLLEGE DISTRICT
Electronic Funds Transfer Disposition
Requisition/Authorization Form
POSITION: ACADEMIC CONTRACT CLASSIFIED CONTRACT
ACADEMIC HOURLY SHORT-TERM / SUBSTITUTES / STUDENTS
NAME:
SOCIAL SECURITY NO:
The policy of the San Bernardino Community College District for the disposition of payroll warrants is to mail the
warrant to the employee’s mailing address by the United States Postal Service
unless one of the following options is
requested in writing:
CANCEL MY E.F.T.
ELECTRONICALLY TRANSFER (EFT) TO MY BANK (Attach bank preprinted deposit slip)
DEPOSITORY (Bank Name):
DEPOSITORY INSTITUTION 9-DIGIT TRANSIT/ABA NO.:
ACCOUNT NO.:
CHECKING OR SAVINGS
I
, shall hold harmless and indemnify the San Bernardino Community
College District, herein after referred to as District, and employees from any claim or demand of whatever nature of
the district and its offers and employees, brought by any person, including any banking institution against the District
in it capacity as an employer concerning the Payroll Warrant Disposition provided by the District.
I hereby authorize the district to initiate credit entries and, if necessary, debt entries and adjustments for any credit
entries in error to my account indicated above. I also authorized the Depository Credit Union/Bank named above
(Depository), to credit and/or debit the same to such account. Electronic funds transfer takes effect one month
following request after a successful prenote test has occurred through the banking system. The above request is
for the monthly disposition of my pay warrant from this date until rescinded in writing.
SIGNATURE:
DATE:
(ACADEMIC CONTRACT & CLASSIFIED CONTRACT EMPLOYEES ONLY)
PICK UP AT:
SBVC CAMPUS BUSINESS OFFICE
CHC CAMPUS BUSINESS OFFICE
DISTRICT OFFICE
FOR CHANGE OF ADDRESS, USE PERSONNEL 001 FORM.
Please return to: District Payroll Department
Payroll 017 Revised 3/2001
