Revised 6/25/15 Input by: __________ Date ___________
Complete the required information below to enroll, change, or cancel your current direct deposit
at Santa Barbara City College. Insert the dollar ($) or percent (%) amount to be deposited.
The following documents must be attached to this form:
For checking accounts, please attach a voided check
For savings accounts, please attach a deposit format letter from your financial instituti
Employee Information
- (Please print legibly)
Last Name K Number
First Name Phone Number
II. Direct Deposit Information
(You have the option to deposit your check into more than one
Circle one:
New Change Cancel
1st Account: Bank/Credit Union Name
Type of Account Routing #
Checking Account #
Savings $ of Net Pay or % of Net Pay
or All of Net Pay
Remainder Account:
(If you did not deposit your entire payroll amount into the account
specified above, the remainder will be deposited into this account.)
Type of Account Bank/Credit Union Name Routing #
Checking Account #
III. Authorization
1. By signing this agreement, I authorize Santa Barbara City College to automatically deposit my net pay into my account(s) each
payday. The college reserves the right to recall or adjust any deposits improperly created and deposited to my account. I understand
my direct deposit service may be suspended or rescinded by the College at any time.
2. It is my responsibility to notify the payroll dept. of any account closures. If the direct deposit is not stopped before closing an
account, I agree to wait until the funds are returned to the College to receive my funds. This could take several days and will delay
my payment.
3. I understand I may revoke my direct deposit authorization at any time by providing written notification to the Payroll Department.
4. It is my responsibility to ensure that my net pay is properly credited to my account before issuing any debits against my account. I
will hold the College harmless for any liability to pay charges for insufficient fund transactions that result from failure within the
Automated Clearing House Network to correctly and timely deposit monies into my account.
5. I agree to hold harmless and indemnify Santa Barbara City College, and their employees, from any claim or demand of whatever
nature, including those based upon negligence, brought by any person, including any financial institution for failure or delay in
making deposits and/or corrections to deposits as herein authorized. This authorization replaces any previously made by me and
remains in effect until I cancel or submit a new authorization.
Signature: _____________________________________ Date: ________
Payroll Department