County Direct Deposit Form
Direct Deposit Authorization Form
I authorize Creek County Clerk to initiate credit entries and to initiate, if necessary, debit entries and adjustments for
any credit entry in error to my account indicated below and the financial insitution named below, to credit and/or debit
the same to such account. This authority is to remain in full force and effect until Creek County Clerk has received
written notification from me of its termination in such time and in such manner as to afford a reasonable opportunity
to act on it.
Date:
Employee Name:
Employee Social Security Number:
Financial Institution Information
Financial Institution:
Address:
City, State and Zip:
Phone Number:
Routing Transit Number: (Normally found on left side of a personal check)
Employee Account Number: (Normally the middle number on a personal check)
Account Type: (Checking or Savings)
Check One:
I am not currently participating in the direct deposit program
Add - Deposit my pay into the account shown
I am currently participating in the direct deposit program
Change - Change financial institutions and/or account number
Cancel - Stop my participation in the program
Please attach a void check.
Allow 1-2 pay periods for processing. You will receive a normal paycheck until the changes have been processed.
Employee Signature