2. 
   

   Please complete this to update your Direct Deposit Information with Human Resources
4. Authorization Agreement
6. I hereby authorize the City of Lebanon to initiate automatic deposits to my account at the financial institution named below. I also authorize the City of Lebanon to make withdrawals from this account in the event that a credit entry is made in error. Further, I agree not to hold the City of Lebanon 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. This agreement will remain in effect until the City of Lebanon receives a written notice of cancellation from me or my financial institution, or until I submit a new direct deposit form to Human Resources.
8. Account Information
10. Name of Financial Institution
12. Routing Number
13. Account Number
14. Account Type
    -- Select One --CheckingSavings
16. Flat Amount
17. Percentage (if not a flat amount)
19. Acknowledgement
21. By typing your name and hitting submit you are authorizing HR to execute the above changes in lieu of your handwritten signature. At your earliest convenience you will need to turn in a voided check to Human Resources. Thank You.
23. Date
    Date
24. Employee Name
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field