Fillable Printable Direct Deposit Authorization Form for One Bank Account - University of Florida

Direct Deposit Authorization Form for One Bank Account - University of Florida

PLEASE READ AND CAREFULLY FOLLOW INSTRUCTIONS

All boxes must be completed; fill-in all information.

Please leave this area blank

This form will start, change, or stop direct deposit for

wage payments received by you from the University of

Florida. If you want to send your direct deposit to more

than one account, please use the ''Direct Deposit

Authorization Form For Multiple Accounts''

New employees: Submit this form to the hiring department.

Current employees: Send the form directly to University Payroll and Tax

Select the Direct Deposit Action Requested:

Services or use My Self Service on myUFL.

Check Start if you do not have direct deposit established. It is

UNIVERSITY OF FLORIDA

DIRECT DEPOSIT AUTHORIZATION

FORM FOR ONE BANK ACCOUNT

PLEASE TYPE OR PRINT CLEARLY

necessary to provide a voided check with your name printed

on it. In lieu of a check, you may offer a bank issued direct

deposit form or a bank letter. The bank documents must be

printed by the bank and signed by a bank representative.

Bank forms cannot be completed and signed by the

employee. Do not submit a deposit slip as the routing

This form will not be processed without your UF ID

numbers differ from the direct deposit routing numbers.

UF ID#

If making a Change to your direct deposit for the financial

institution, the account number, or the routing number, there

Last Name First Name

M. I.

are 2 options.

1 . Preferred Option (no forms needed): Employee

changes the direct deposit in My Self Service >

Payroll and Compensation > Direct Deposit.

2. Check Change on this completed form and provide a

voided check, bank form, or bank letter as stated

above.

You do not need to submit a new form when changing

departments/positions within the University.

AGREEMENT

I hereby authorize and request the University of Florida to

initiate credit entries and, if necessary, a debit entry in

accordance with NACHA rules reversing a credit entry made in

error, to my account at the financial institution named. Direct

deposit data remains active in University Payroll and Tax

Services until one year after separation of employment or until

changed by:

Start

(1)

Direct Deposit Action Requested

(Check only one)

(2)

Change

(a) me in writing by submitting this form requesting a change;

(b) me by submitting a change in My Self Service in myUFL;

(d) the financial institution or;

(e) the University of Florida.

(1)

Checking

Account Type

(Check only one)

(2)

Savings

Your Account Number

I understand that I am required to stop or change my direct

deposit information with the University of Florida before I close

my bank account.

Transit Routing Number of Your Financial Institution

Special Note: If you need assistance or have questions about

your direct deposit, please call University Payroll and Tax

Services at (352) 392-1231.

A voided personal check that includes your imprinted name

or form/letter from your financial institution that includes

the account holder's name, account number, and routing

number must be attached here for account verification.

**Do not attach a deposit slip. Forms with deposit slips

attached will be rejected since the banking codes are not

valid for direct deposit.

New Hires: Changes:

Include form and voided

Fax to: (352) 846-0166

imprinted check with If you fax your form, retain

payroll packet. Send

the original; do not also mail

THIS FORM MUST BE SIGNED AND DATED BY PAYEE

Signature above signifies acceptance of the terms and conditions in the

AGREEMENT to the right.

completed packet to the the original to Payroll and

Tax Services.hiring department.

Telephone: (352) 392-1231

FA-PS-DDA 07/2011

Local Mailing Address (Number, Street, Apt #)

City

State

Zip Code

Telephone

Email Address

Name of Your Financial Institution

Telephone Number of Your Financial Institution

Employee's Signature

Date