Direct Deposit Authorization

 Colton-Pierrepont Central School

 Colton, NY 13625

I hereby authorize Colton-Pierrepont Central School to forward directly to:

 (Banking Institution Name) _________________________________________________

My payroll checks for credit to my account. This authorization is to remain in effect until such time as it is revoked by me in writing.

Routing Number __________________________________________________________

Checking/Savings Account Number __________________________________________

 Amount $_______________________________________________________________

Signature _____________________________________ Date_____________________