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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