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DIRECT DEPOSIT AUTHORIZATION <br /> <br />I authorize the Orange County Sportsplex to deposit my pay automatically to the account(s) <br />indicated below and, if necessary to adjust or reverse a deposit for any payroll entry made to <br />my account in error. This authorization will remain in effect until I modify or cancel it in writing. <br /> <br />Please print and complete ALL the information below: <br />Full Name: ____________________________________________ Social Security #: ______ - _____ - ________ <br />Address: ___________________________________________________________________________________ <br />City, State, Zip: ______________________________________________________________________________ <br />This authorization is for: ☐ New Direct Deposit <br /> ☐ Deposit Change <br /> ☐ Cancel My Direct Deposit <br />Attach a voided check here for each bank account to which funds should be deposited (if available) <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Name of Bank: ______________________________________________________________________________ <br />NOTE: Savings and Credit Union accounts may use different routing and/or account numbers for ACH transactions. It is each employee’s <br />responsibility to call their bank and acquire the correct information for initiating direct deposits into such accounts. Deposit Slips Are <br />Not Valid. <br /> <br />I understand I am responsible for confirming that my pay has been properly deposited each payroll. No transactions will be in itiated <br />against those funds until that confirmation has been made. Any Non-Sufficient Funds charges that occur because I have failed to <br />abide by this will be my responsibility. <br />______________________________________________ _________________________ <br />Employee Signature Date <br />CHECKING DEPOSIT <br /> <br />9-Digit Bank ABA Routing #: _______________________ Account #: ________________________________ <br /> <br />I wish to deposit to checking: ☐ A flat amount of $ ___________.00 <br />☐ _________ % of my net pay <br /> ☐ My entire net pay <br /> <br />SAVINGS or OTHER DEPOSIT <br /> <br />9-Digit Bank ABA Routing #: _______________________ Account #: ________________________________ <br />I wish to deposit to: ☐ Savings ☐ A flat amount of $ ___________.00 <br /> ☐ Other ☐ _________ % of my net pay <br /> ☐ My entire net pay <br /> <br />Docusign Envelope ID: 177AA06A-30B4-42FF-A85A-78B5A7C51DBE