Seven Hillscharterschool

Seven HillsCharterSchool

Employee Information

Employee Name: / Soc. Sec. #:

Depository Information

Please fill out the bank account information below if you wish to have all or a portion of your pay directly deposited into

your bank accounts.

You must attach a voided check, voided savings deposit form, and/or credit union draft from bank account(s) to this form.

Account 1 (Please choose one of the following):
Add to Direct Deposit
Stop Direct Deposit
Change Direct Deposit / Type of Account:
Checking (attach voided check)
Savings (attach savings slip) / Amount to Deposit:
Total Net Pay
Dollar Amount $
Percent %
Bank Name: / Bank Routing Number: / Bank Account Number:
City/State:
Account 2 (Please choose one of the following):
Add to Direct Deposit
Stop Direct Deposit
Change Direct Deposit / Type of Account:
Checking (attach voided check)
Savings (attach savings slip) / Amount to Deposit:
Total Net Pay
Dollar Amount $
Percent %
Bank Name: / Bank Routing Number: / Bank Account Number:
City/State:
Account 3 (Please choose one of the following):
Add to Direct Deposit
Stop Direct Deposit
Change Direct Deposit / Type of Account:
Checking (attach voided check)
Savings (attach savings slip) / Amount to Deposit:
Total Net Pay
Dollar Amount $
Percent %
Bank Name: / Bank Routing Number: / Bank Account Number:
City/State:

I authorize my employer as noted above, AdminaService, Inc., Cachet Banq and all financial institution(s) involved in each transaction to deposit my pay automatically to the indicated account(s) and to make adjusting entries including the removal of funds if the employer does not make them available, in which case, I waive any rights I may have to return debit entries to my account and I personally guaranty the return of the funds in question. It is my responsibility to verify deposits on a per pay period basis before writing checks against these funds. I understand that neither my employer, AdminaService, Inc. or Cachet Banq is responsible for bank errors or bank fees. Direct Deposit Financial Services are provided in accordance with AdminaService, Inc.’s direct Deposit Agreement, Cachet Banq’s Power of Attorney/Guaranty/Terms and Conditions and the limitations and restrictions of the National Automated Clearing House Association (NACHA). I may cancel these Direct Deposit(s) at any time.

Employee Signature: Date:

Co-Signature (If joint account): Date: