Fillable Printable Direct Deposit New Enrollment Form - New York
Fillable Printable Direct Deposit New Enrollment Form - New York
Direct Deposit New Enrollment Form - New York
THE CITY OF NEW YORK
PAYROLL MANAGEMENT SYSTEM
Direct Deposit of Net Pay
Enrollment
SUBMIT COMPLETED FORM TO:
EMPLOYEE SECTION
EMPLOYEE
IDENTIFICATION
WORK TELEPHONE
TSAL.I.MTSRIF
REFERENCE NUMBER
AGENCY PAYROLL SECTION
CHECK DIGIT
# LLORYAPNSJ # TNEMUCOD
ENROLLMENT
REJECTION REASONS
INACTIVE
LEAVE STATUS
OTHER
ENTERED INTO PMS
MANAGER/ SUPERVISOR
Signature
Name
(Please Print)
Signature
Name
(Please Print)
EMPLOYEE AUTHORIZATION
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 the 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.
EMPLOYEE
SIGNATURE
ENROLLMENT
PERSON(S) NAMED ON ACCOUNT (PRINT EXACTLY - INCLUDE TRUSTEE OR JOINT OWNER)
PERSON 1
PERSON 2
*ABA BANK NUMBER:
CHECKING ACCOUNTS --
The ABA number is the first nine (9) numbers prior to the account number at the bottom left corner of the check.
SAVINGS ACCOUNTS --
Contact your bank for ABA number, if not known.
ABA NUMBER* ACCOUNT NUMBER** ACCOUNT TYPE
SAVINGS CHECKING
(CHECK ONLY ONE)
(**See check, passbook or account statement for account number)
TYPE OF
ACTION
Attach a voided check or most recent savings statement.
NEW
ENROLLMENT
AGENCY
CITY OF NEW YORK EMPLOYEES ONLY
MONTH DAY YEAR
MONTH DAY YEAR
MONTH DAY YEAR
YOUR AGENCY DIRECT DEPOSIT COORDINATOR OR
YOUR PAYROLL OFFICE
www.NYC.gov/payroll
