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Direct Deposit

DIRECT DEPOSIT ELECTION FORM

Bon Homme School District #04-2

 

Employee Name:  _________________________________________________________

 

BANK #1

Bank Name: _____________________________________________________________

Bank Address:____________________________________________________________

Bank Phone Number:______________________________________________________

 

Employee’s Bank Account Number: __________________________________________

Account Type: (Check one)   ______ Checking Account  OR  ________ Savings Account

Amount of deposit:    $__________ (Designate amount)   OR   _____ Total Check

 

Employee’s Bank Account Number: __________________________________________

Account Type: (Check one)   ______ Checking Account  OR  ________ Savings Account

Amount of deposit:    $__________ (Designate amount)   OR   _____ Total Check

 

Employee’s Bank Account Number: __________________________________________

Account Type: (Check one)   ______ Checking Account  OR  ________ Savings Account

Amount of deposit:    $__________ (Designate amount)   OR   _____ Total Check

 

BANK #2

Bank Name:__________________________________________________________

Bank Address:_________________________________________________________

Bank Phone Number:___________________________________________________

 

Employee’s Bank Account Number: __________________________________________

Account Type: (Check one)   ______ Checking Account  OR  ________ Savings Account

Amount of deposit:    $__________ (Designate amount)   OR   _____ Total Check

 

Employee’s Bank Account Number: __________________________________________

Account Type: (Check one)   ______ Checking Account  OR  ________ Savings Account

Amount of deposit:    $__________ (Designate amount)   OR   _____ Total Check

 

I authorize the Bon Homme School District to implement Direct Deposit of my monthly paycheck using the above information.

 

________________________________________                ___________________

Employee Signature                                                                Date

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