ABCDEGHIJKLMNOPQRSTUVWXYZ
1
2
3
4
MADISON COUNTY
5
BOARD OF COMMISSIONERS
6
7
8
Direct Deposit Authorization Form
9
10
11
12
13
14
Employee Name:
15
16
17
18
ENROLLMENT
19
20
I hereby authorize Madison County to direct deposit my payroll check in the following
21
account that I have specified by attaching a VOIDED CHECK or entering the account
22
information in the area below.
23
24
25
26
 CANCELLATION
27
28
I hereby authorize Madison County to discontinue direct deposit of my payroll check.
29
30
31
32
CHANGE
33
34
I hereby authorize Madison County to cancel my current direct deposit information of
35
my payroll check and change it to the account information that I have specified in the
36
area below.
37
38
39
40
CHECKING
SAVINGS
41
42
43
Financial Institute Name:
44
45
Account #:
46
47
 Routing #:
48
49
50
51
52
53
54
55
Employee signature:
 Date:
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100