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
REJECTIONREASONS
INACTIVE
LEAVE STATUS
OTHER
ENTERED INTO PMS
MANAGER/ SUPERVISOR
Signature
Name
(Please Print)
Signature
Name
(Please Print)
EMPLOYEEAUTHORIZATION
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)NAMEDONACCOUNT (PRINT EXACTLY - INCLUDE TRUSTEE OR JOINT OWNER)
PERSON1
PERSON2
*ABABANKNUMBER:
CHECKINGACCOUNTS--
The ABAnumber isthe firstnine(9) numbersprior to theaccount number at thebottomleft corner of the check.
SAVINGSACCOUNTS --
Contact your bank for ABA number, if not known.
ABA NUMBER*ACCOUNT NUMBER**ACCOUNT TYPE
SAVINGSCHECKING
(CHECK ONLY ONE)
(**See check, passbook or account statementforaccount number)
TYPE OF
ACTION
Attach a voidedcheck or mostrecent savings statement.
NEW
ENROLLMENT
AGENCY
CITY OF NEW YORK EMPLOYEES ONLY
MONTHDAYYEAR
MONTHDAYYEAR
MONTHDAYYEAR
YOUR AGENCY DIRECT DEPOSIT COORDINATOR OR
YOUR PAYROLL OFFICE
www.NYC.gov/payroll
