PM3 01/1
4/2020
TOWN OF ROWE
Authorization Agreement for Automated Deposits
I (we) hereby authorize the TOWN OF ROWE, hereafter called COMPANY, to initiate credit entries and to initiate, if necessary, debit entries and
adjustments for credit entries in error to my (our) account(s) indicated below and Depository named below, hereafter called DEPOSITORY, to credit
and/or debit the same to such account. Please include ALL depositories each time you make a change.
Only Choose One For Each Line
Routing Number
(9 Digits)
Net
*Direct Deposits will be allocated by order until the entire amount of your paycheck is deposited. Use additional sheets if you have more than three
accounts.
This authority is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in
such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.
(If joint account, both account holders must sign this authorization agreement)
Name (print) ________________________________________________
Signature ________________________________________________ Date _____________
Name (print) ________________________________________________
Signature ________________________________________________ Date _____________
Return completed authorization form to: Town of Rowe
Treasury Department
PO Box 462
Rowe MA 01367
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