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Direct Deposit Authorization Form
Part/Full Time Employee
HR Form 3. Rev 11.21.14BJ
Instructions:
1. Please complete the Authorization Agreement and Bank Information sections of this form.
2. For a checking account, include a blank voided check or statement from your bank indicating the ACH routing number and account number.
3. For a savings account, obtain a statement from your bank indicating the ACH routing number and account number.
4. A deposit form will not be accepted as proof of routing number or account number.
5. A maximum of three accounts can be setup. You may elect to have designated funds be deposited into the account of your choice with the remainder
deposited into the latter.
6. Direct deposits are made on a semi monthly basis. Full time employees are paid on real time, however part time employees are paid two weeks in arrears.
Please allow two pay periods from the date of submission for the direct deposit to be activated.
7. Return this completed form and appropriate attachments to Payroll Dept., 400 Paramus Rd, Rm. A228, Paramus, NJ 07652.
Please check one box: Initial Enrollment Change Bank Info Cancellation
Section I: Employee Information
Name ________________________________
BCCID# ________________________________
Email ________________________________
Phone ________________________________
Section II: Financial Institution Information
Bank Name:
______________________________
City/State/Zip:
____________________________
Branch Name:
__________________
Telephone#
_____________________
Transit Routing #/ABA: (9 Digits) Account Number: Type of Account: Amt:
1. _______________________ 1. _______________________ Checking Savings $ ___________
2. _______________________ 2. _______________________ Checking Savings $ ___________
3. _______________________ 3. _______________________ Checking Savings $ ___________
Section III: Authorization Agreement and Signature
I authorize Bergen Community College to make electronic deposits of payments as indicated above to my account each payday. If funds to which I
am not entitled are deposited to my account, I authorize the College to direct the financial institution to return said funds. Or I can authorize Bergen
Community College to discontinue my service for direct deposit with the above financial institution effective immediately. I understand I must give
advance notice to allow reasonable time for my instructions to be executed.
I understand that it is my responsibility to verify that payments have been credited to my account and the College assumes no liability for overdrafts
for any reason. I understand in the event my financial institution is not able to deposit any electronic transfer into my acc ount due to any action I
take, the College cannot issue funds to me until the funds are returned to the College by my financial institution.
I understand this authorization will override any previous authorization and will remain in effect until a) revoked thru the above signed cancellation
process; b) immediately following my termination from employment with the College; or c) 120 days after my last paycheck was issued.
I understand I must immediately notify the Payroll Department before I close my account listed above while this authorization is in effect.
Employee Signature ______________________________________________ Date _________________________
Section IV: Payroll Office Only
Rcvd/Initialed By Payroll:
______________
Payroll Rep:
________________
Date Direct Deposit Initiated/Cancelled by Payroll:
____________________________________________