Fillable Printable Employee Authorization for Direct Deposit of Payroll - Georgia Southwestern State University
Fillable Printable Employee Authorization for Direct Deposit of Payroll - Georgia Southwestern State University
Employee Authorization for Direct Deposit of Payroll - Georgia Southwestern State University
GEORGIA SOUTHWESTERN STATE UNIVERSITY
EMPLOYEE AUTHORIZATION FOR DIRECT DEPOSIT OF PAYROLL
AMOUNT TO DESIGNATED BANKING INSTITUTION
I,
(Employee’s Name – Please Print) (Department)
do hereby authorize the Payroll/Accounting Services Department of Georgia Southwestern State University,
Americus, Georgia, to electronically deposit my payroll amount directly in (please indicate):
DESIGNATE:
Checking Savings
CITIZENS BANK OF AMERICUS To Account Number
DOCO CREDIT UNION To Account Number
FIRST STATE BANK To Account Number
PEOPLES COMMUNITY BANK To Account Number
SUMTER BANK & TRUST To Account Number
WELLS FARGO/WACHOVIA To Account Number
of
To Account Number
(Other Banking Institution)
I understand that this agreement authorizes direct deposit of my payroll amount, intact, on each regular
scheduled pay date, in the banking institution indicated by employee.
I understand that my funds will be
available to draw on the specified check date.
Georgia Southwestern State University provides direct deposit as a service to all employees and therefore,
is not responsible for any loss, failure to deposit or to credit any account on the day of deposit by any
banking institution accepting transfers under this agreement.
This authorization shall remain in effect until withdrawn in writing to the Payroll Department of Georgia
Southwestern State University.
EMPLOYEE’S SIGNATURE NAME(S) ON ACCOUNT
DATE: ________________ _____, 20 ___.
PLEASE ATTACH A CHECK MARKED VOIDTO VERIFY BANK ROUTING NUMBERS
AND RETURN TO GSW PAYROLL DEPARTMENT.
(Rev. 1/2011)
