443-809-4240 (Office), 410-887-7610 (Fax) BALTIMORE …
Office of Payroll 6901 N. Charles Street, Building E Towson, Maryland 21204 443-809-4240 (Office), 410-887-7610 (Fax)
BALTIMORE COUNTY PUBLIC SCHOOLS
DIRECT DEPOSIT AGREEMENT FORM
AUTHORIZATION AGREEMENT
I hereby authorize the Office of Payroll to initiate automatic deposits to my checking or savings account at the financial institution
named below. I also authorize the Office of Payroll to make withdrawals from this account in the event that a credit entry is
made in error.
I understand that failure to notify the Office of Payroll of a change in account information may result in funds being sent to the
incorrect financial institution or account and subsequently delay access to deposited funds. If it is necessary to cancel a direct
deposit, I understand the Office of Payroll must wait until the depositing funds are returned. This process takes five (5) business days,
on the sixth day a check will be prepared.
I understand the payroll statements (stubs) will be available in Employee Self Service (ESS) and if I wish to opt-out of electronic
payroll statements, I need to send an e-mail to the Office of Payroll (office of payroll@) requesting the payroll stubs
be mailed to my home.
Further, I agree not to hold the Office of Payroll responsible for any delay or loss of funds due to incorrect or incomplete information
supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds
to my account.
Direct Deposit could take up to two pay cycles before it goes into effect and this agreement will remain in effect until the Office
of Payroll receives a revised form cancelling or changing the agreement.
**Please do not use the account information from a deposit slip. Only provide the information from your check**
Employee and Account Information
New
CHANGE
CANCEL
First and Last Name Employee ID or Last 4 SS# Contact Phone Number
Position
Account Type Savings
Routing Number
Account Number
Checking * * If requesting a checking account, please attach a copy of a voided check.
Name of Financial Institution
Authorizing Signature
Date
................
................
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