RED CREEK CENTRAL SCHOOL DISTRICT

PO BOX 190, RED CREEK, NEW YORK 13143

AUTHORIZATION AGREEMENT

I hereby consent to and authorize Red Creek Central School District, to deposit my payroll wages in the account in my name, at the Bank indicated below, and authorize Bank to credit such amount to:

Indicate type of account (check one): _____ Checking or _____ Savings

Amount of transaction _____ Net wages or $ _____ Dollar amount

Name of Bank or Savings Association _____________________________________________

City, State, Zip _____________________________________________

Bank Routing & Transit Number | : ____ ____ ____ ____ ____ ____ ____ ____ ____ : |

Account Number ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____

Red Creek Central School (RCCS) is authorized to make corrections to this account to adjust any over-deposit which it has caused to be made. RCCS may only correct an error within five (5) days or prior to the clearance of said deposit. RCCS may only make a correction in an amount equal to the deposited amount and only for the pay period in which the error occurred. The District will notify the employee of the correction immediately.

This authorization is to remain in full force and effect for the duration of my employment, or until RCCS may wish to discontinue the service, or until RCCS has received written notification from me of its termination in such time and manner as to afford RCCS and my bank a reasonable opportunity to act on it.

Employee Name (Please print) _____________________________________________

Employee Signature _____________________________________________

Social Security Number _____________________________________________

Date _____________________________________________

I have attached a voided check (for checking accounts) or deposit ticket (for savings accounts) to this authorization.