DIRECT DEPOSIT AUTHORIZATION FORM
Payroll deposits can be made to a maximum of three (3) accounts. If you elect a direct deposit, you cannot request to receive a portion of your pay in the form of a hard copy check. Only one (1) account may be designated to receive “Net Pay”. It is our policy to pre-note any additions or changes to direct deposit accounts. A pre-note is a zero dollar transaction sent to your bank to verify your account information. Depending on when the form is submitted, it may take up to two (2) pay periods before additions or changes become effective.
Bank Account #1: Enroll Cancel Change
Bank Name: ______ / Routing # (9 digits): ______
Account #: ______ / Checking Savings
NET PAY or Amount you wish to withhold per pay period: $______
Bank Account #2: Enroll Cancel Change
Bank Name: ______ / Routing # (9 digits): ______
Account #: ______ / Checking Savings
NET PAY or Amount you wish to withhold per pay period: $______
Bank Account #3: Enroll Cancel Change
Bank Name: ______ / Routing # (9 digits): ______
Account #: ______ / Checking Savings
NET PAY or Amount you wish to withhold per pay period: $______
Authorization:
I authorize my employer to deposit my pay into the account(s) indicated above. I will not hold my bank liable for any erroneous deposits or adjustments made by my employer. I understand that I must check with my bank to verify that my account has been credited before engaging in any financial transactions.
Name (last, first, middle): ______ / Employee ID: ______
Department Name: ______ / Work Number: ______
Employee - Signature: ______Date: ______
Instructions:
Print form – sign and attach a copy of a voided check for each account and submit to:
Gannett Employee Services Fax #: ______
Revised 08/14/2013