DIRECT DEPOSIT 

NEW                      CHANGE                        

A current voided check is required with this form to be attached for proper account #/bank routing # information.  

Employee #/Name: #                  /                                                                                                      

Account name you wish to direct deposit to:                                                                                     
 (Example: Mr. Or Mrs. Steve Adams)

Your Checking/Savings Account #: ______________________ Routing #: _________________

Bank Name: ___________________________________________________________      ___

I request that the payroll department of the Itawamba County School District direct deposit my monthly payroll amount to the above account beginning _____________________.  I understand that by enrolling in the direct deposit program that my payment amount will be deposited into my account each payday.  In addition, I understand in lieu of an actual check, I will receive an advice of direct deposit informing me of the dollar amount deposited into my account, as well as all the YTD information currently appearing on my check stub.  If you choose to deposit into a savings account, I will need the correct routing number.  You will need to contact your bank for that.

_____________________________________________	                 /            /                
                   Employee Signature				         Date

Payroll procedures require that any changes affecting direct deposit must be received by the payroll office no later than the 10th of the applicable month.

If you are using a savings account, please have your bank complete the routing number and account number and a representative sign below for the verification.

Signature of Representative			     Date