Direct Deposit Authorization Agreement

www.annaisd.org • 501 S. Sherley Ave. • Anna, Texas 75409 • (972) 924-1000 • FAX (972) 924-1001

Employee ID*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
First Name*field type drop-down
Last Name*field type drop-down
Department/Campusfield type drop-down
Employee DOBfield type date
Employees Emailfield type single line
Input blocked. Maximum character limit of 4000 characters reached.

Applicant ID*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
First Name*field type drop-down
Last Name*field type drop-down
Job*field type drop-down
Applicant DOBfield type date
Applicants Emailfield type single line
Input blocked. Maximum character limit of 4000 characters reached.

I hereby authorize Anna ISD, hereinafter called Anna ISD to initiate credit entries and to initiate, if necessary, debit entries and adjustments for any credit entries made in error to my (our) account (accounts) indicated below and the depository names below, hereinafter called BANKING INSTITUTION, to credit and/or debit the same to such account.
Change Typefield type drop-down
I hereby request that Anna ISD cancel my current Direct Deposit. I understand that this termination must be received 15 working days prior the specific pay date.

Deposit Information

Show Check Examplefield type checkbox
Show Check ExampleShow
Deposit Information
×
- Bank Namefield type single line
  Input blocked. Maximum character limit of 4000 characters reached.
- Account Typefield type drop-down
- Routing #*field type single line
  Input blocked. Maximum character limit of 9 characters reached.
- Confirm Routing #*field type single line
  Input blocked. Maximum character limit of 9 characters reached.
- *Routing #'s must match!*
- Account #*field type single line
  Input blocked. Maximum character limit of 4000 characters reached.
- Confirm Account #*field type single line
  Input blocked. Maximum character limit of 4000 characters reached.
- *Account #'s must match!*
Add Another Deposit
I understand that is my responsibility on the initial deposit to check with my bank and confirm that the deposit has been credited to my account and inform the payroll department if the deposit has not been paid.
I understand this authority is to remain in full force and effect until Anna ISD has received written notification from me of its termination.
Direct deposit information, including changes must be received by the payroll department no less that 15 business days before pay day in order to process on the next check.

BY CLICKING THE SUBMIT BUTTON BELOW, I AM PROVIDING MY ELECTRONIC SIGNATURE WHICH INDICATES MY RECEIPT, UNDERSTANDING, AND AGREEMENT TO THE ABOVE TERMS. I UNDERSTAND AND AGREE THAT MY ELECTRONIC SIGNATURE CARRIES THE SAME FORCE AND EFFECT AS MY HANDWRITTEN SIGNATURE.

	Datefield type date	First & Last Name*field type single line	Date of Birth*field type date	Accept*field type checkbox
row 1	Datefield type date	First & Last Name*field type single line Input blocked. Maximum character limit of 4000 characters reached.	Date of Birth*field type date	Accept*field type checkbox AcceptAccept

First Namefield type single line
Javascript fills from either emp or app first name
Input blocked. Maximum character limit of 4000 characters reached.
Last Namefield type single line
Javascript fills from either emp or app last name
Input blocked. Maximum character limit of 4000 characters reached.
IDfield type single line
Javascript fills from either emp or app id
Input blocked. Maximum character limit of 4000 characters reached.
Emailfield type single line
Javascript fills from either emp or app email
Input blocked. Maximum character limit of 4000 characters reached.
DOBfield type date
Javascript fills from either emp or app email
Process Typefield type drop-down