AUTOMATIC DEPOSIT AUTHORIZATION INSTRUCTIONS
Do not fill out or submit this form for change of Address or Name change.
1. Social Security Number
Enter employee social security number.
Type or print employee name exactly as it appears on your account.
3. Type of Account
Indicate whether your account is a checking or savings account or paycard. If
paycard is selected see number 9.
4. Financial Institution Name Enter the name of the bank, savings and loan or credit union where your account is
held, i.e.: Bank-One.
5. Financial Institution, City, State
Enter the city and state of your financial institution.
6. Employing Agency
Enter the name of the state agency you work for.
7. Signature and Date Sign and date the request form. NOTE-A request form cannot be processed
without your signature as authorization.
8. Voided Check For deposit to a checking account, attach to this request a VOIDED
check from the
financial institution of your choice so that we can use the information to make a
proper deposit. For a deposit to a savings account, provide a document from your
financial institution showing the financial institution’s routing number and your
account number. NOTE-A request form cannot be processed without this
information. Thank you.
9. Paycard If paycard is selected, place the following information in the Financial Institution
box: First Financial Bank ABA 084 003 997
WHAT HAPPENS NEXT
When your payroll, spending, and/or travel reimbursement is included in the Direct Deposit system, or the Paycard you
will receive a Notice of Deposit instead of a warrant. The pay stub will not change, you will continue to receive a record of
If you should have any problems, follow the procedures listed below:
1. Call your bank and ask for Commercial Direct Deposit Assistance. Advise them that you are on direct deposit through
“ACH” (Automated Clearing House). If you still have problems, ask to speak to an Officer of the Bank, a Teller
Supervisor or a Customer Service Representative. Write down the names of the people you talk to and the phone
number you called.
2. For Payroll Deposits
If you are not satisfied with the results for pay warrants, contact the payroll office of your employer, Direct Deposit
Unit. You must have completed Step 1 before calling the Direct Deposit Unit. We will need the Phone Numbers and
Names of the people you talked with at your bank.
3. For Travel Deposits
If you are not satisfied with the results for travel warrants, contact your agency representative(s) who processes your
4. For Spending Account Deposits
If you are not satisfied with the results for spending account warrants, contact Spending Accounts Administration at
the Employees Benefit Council (405) 232-1190.
5. For Paycard Deposits
Contact MoneyNetwork Customer Service – 1-800-913-0900 or www.moneynetwork.com
. Then follow the procedures
in Step 1.