Shaded Area for Payroll Use Only
Received
Prenoted Deposited
DIRECT DEPOSIT AUTHORIZATION FORM
Name:_______________________________________________________________________
Last Name First Name MI
SSN:____________________________________
Payroll Type: Semi-Monthy Monthly
______START: I authorize you and the financial institution listed below to deposit my
net pay automatically to my account(s) each payday, and to initiate adjustments, if
necessary, for any entries made in error to my accounts.
______CHANGE Checking and/or Savings: I authorize you to change my direct deposit
to the account(s) at the financial institution listed below.
______STOP: I authorize you to stop the direct deposit of my net paycheck.
Institution Name__________________________ ________% of net check or $___________
Account Type: _____Checking _____Savings Account Number: _______________________
Bank Routing /Transit Number: ___ ___ ___ ___ ___ ___ ___ ___ ___
A VOIDED CHECK MUST BE PROVIDED IN THE SPACE BELOW
Routing/Transit Number - Account Number - This is Check Number - The financial institution scans the
Routing/Transit is a 9-digit your checking account check number electronically in order for it to appear on
number that identifies the number. your monthly statement.
financial institution where
your checking account is
located.
Signature: _______________________________________ Date: ___________________
DIRECT DEPOSIT INFORMATION
1. The payroll deposit authorized by the employee’ signature on the Direct Deposit
Authorization form is accomplished by a process known as electronic funds transfer. It is
covered by a number of Federal regulations designed to safeguard the integrity of the
employee’s account
2. The funds deposited should be available to the employee for withdrawal by all regular
means on the morning of the scheduled payday.
3. The electronic funds transfer system requires an additional step known as pre-
notification. This is a procedure whereby account numbers must be verified by the
receiving financial institution before we will transmit direct deposit data to them.
Therefore new authorizations, changes, or cancellations should be in the Payroll
Department one month prior to the month the authorization, change or cancellation is to
take effect. If the authorization cannot be processed, Payroll will notify the employee,
who will continue to receive a payroll check until the authorization can be processed.
4. The pre-notification process also dictates that if a change in the financial institution or
account number is made, the employee must be removed from direct deposit for a
minimum of one pay period before the change will take effect. For the payday(s) the
employee will receive a payroll check(s).
5. Cisco College assumes no responsibility to issue a payroll check to any employee whose
direct deposit could not be processed due to his/her account being closed, or any other
reason, until the receiving financial institution has either refunded or guaranteed refund
of such deposit to the College.
RETURN COMPLETED FORM TO:
Cisco College
Human Resources Office
101 College Heights
Cisco, TX 76437
