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Authorization for Payroll Direct Deposit city of Eugene <br /> I, ,Employee # authorize <br /> (print your name) <br /> the City of Eugene to deposit my pay directly to the checking or savings account(s) indicated below. <br /> You may deposit your entire pay to one account only, or you may split your pay and deposit a set amount to <br /> one financial institution with the balance of your wages going to a different institution. <br /> It will take at least two pay periods for the direct deposit to begin. On the upcoming pay day, you will <br /> receive a regular check that will have to be manually deposited so that a "test deposit" can be done with your <br /> financial institution(s). Provided that there are no problems with your account(s), your pay will be direct <br /> deposited the. following pay day. <br /> Directions: 1 1 Check oitN ot~thc t~~o hogs below and con~plctc ihci~ec{uirrd inlurniiition. 2).~tttaclr a <br /> voided chock(s) ur dcE~osit slip(s). ll~ncithcr is ati~ailahlc, attach anv document I~ron~ the fnancial <br /> n~stiiution ~s~ith Phr aeci~unt number imprinted omit. Sign anti date this i'orm and send it to Central <br /> - <br /> y <br /> Q+ ? <br /> I would like my entire pay to be deposited to: <br /> Name of Financial Institution: <br /> <br /> -o <br /> o Routing Transit # (number on bottom left side of check): <br /> x Account # Checking Savings <br /> (check only one) <br /> b ~ I would like to split my pay between the following two accounts: <br /> 0 <br /> $ per pay period to be deposited to: <br /> p. exact amount o pay <br /> c~ <br /> ~ Name of Financial Institution: <br /> Routing Transit # (number on bottom left side of check): <br /> Account # Checking Savings <br /> (check only one) <br /> The balance of my pay is to be deposited to: <br /> Name of Financial Institution: <br /> Routing Transit # (number on bottom left side of check): <br /> Account # Checking Savings <br /> (check only one) <br /> :~;s~= :a:.y. <br /> , <br /> .,,.,w_ _ <br /> i:~ L~la~o ~3r; L Lt7a i©o LDi©v Lin , . <br /> ~-R'T'E-~ t~c~a~un~f~l~rk~~rr~ <br /> Employee Signature: Date: <br /> <br />