EFT/Drafting Authorization Form

EFT/DRAFTING AUTHORIZATION AND AGREEMENT

Bank Draft - I hereby authorize the Board of Retirement & Insurance to draft payments electronically from my checking/savings account. To ensure that my account is properly debited, I have attached a voided check (or official bank form including routing and account number) from my account where my payments will be withdrawn, and completed the form below. I acknowledge that the bank draft will take place on the first business day of each month. I agree that this authorization will remain in effect until I provide notification terminating this service.

Direct Deposit - I hereby authorize the Board of Retirement & Insurance to deposit payments electronically into my checking/savings account and to initiate, if necessary, debit entries and adjustments for any credit entries in error to my account. To ensure that my account is properly credited, I have attached either a voided check from my checking account, official bank form including routing and account number, or a deposit slip from my savings account, where my payments will be deposited. I acknowledge that the direct deposit will take place on the first business day of each month. I agree that this authorization will remain in effect until I provide notification terminating this service.

Please select a draft or deposit option

PERSONAL INFORMATION

Please select your account type

VOIDED CHECK

Please scan in and upload a voided copy of your check or official bank form which includes routing and account number

SIGNATURE

Use your mouse (or finger if on a mobile device) to sign your name in the box below.