AUTHORIZATION AGREEMENT FOR AUTOMATIC
    DEPOSITS (ACH CREDITS)
  




I hereby authorize Grand Rapids Community College (the Company, hereinafter referred to as the Company).

To make deposits from time to time in the account(s) identified below at the following Depository Financial Institution(s) 
(hereinafter referred to as DFI) and authorize the DFI to accept these deposits. Adjusting entries to correct errors are also 
authorized. It is agreed that these deposits and adjustments may be made electronically and under the Rules of the 
National Automated Clearing House Association. This authorization will remain in effect until written notice of termination 
is given to the Company. I acknowledge receipt of a filled in copy of this Authorization. Payroll must be notified when 
you make any changes to your financial institution or accounts.

_______________________________________________________         _____________________________________________
Name                                                                                                 Social Security No.     


_________________________________________________________________________________________________________
Address     


________________________________________________________         ________________         _______________________
City						           State	                Zip Code


______________________________________________________________        _______________________________________
Signature					                                     Date





_________________________________________________________________________________________________
Name of Bank (DFI)


___  ___  ___  ___  ___  ___  ___  ___  ___			________________________________________
Routing & Transit No.				                Account Number


					                    Checking  		Savings  


  


[Please attach your Voided Check here to this Authorization Form]


Upon receipt of this form, your Direct Deposit will start on the __________  pay date if all of the above 
Routing/Transit and Account Numbers are correct.


Please note that your first check will be mailed to your home address even though it says Direct Deposit above 
your name.  Please do not throw this check away. You will still need to cash this check before your Direct 
Deposit takes effect.  After this, an Advice (a copy of what your check looked like before Direct Deposit) will 
automatically be mailed to your home.


Updated on 20-FEB-02
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