Fillable Printable Direct Deposit Authorization Form - Illinois

Direct Deposit Authorization Form - Illinois

Illinois Institute of Technology Direct Deposit Authorization Form

Name: ___________________________________________ Banner ID: _____________________________

Employing Department: _________________________ Email Address: _______________________

CATEGORY: FACULTY / STAFF [ ] OR STUDENT WORKER [ ]

I hereby authorize Illinois Institute of Technology Payroll Services to:

[ ] START - New Direct Deposit

[ ] STOP - Direct Deposit (Designate the account to stop) [ ] PRIMARY [ ] SECONDARY

[ ] CHANGE - my Direct Deposit as follows:

( ) Change all (a change replaces all currently active direct deposit allocations). Fill in each line of

bank information to show how your check should be now.

( ) Add new account(s) (existing accounts will remain unchanged).

( ) Remove account(s) (other accounts will remain unchanged). You MUST have a primary account.

( ) Change amount to be deposited into secondary account.

All new account(s) setups must have attached a voided check or documentation from the bank showing the Bank Routing Number and the

actual Account number. If these documents are not attached, the verification of the banking information may take up to two pay periods

provided there are not errors returned on your account and your account will “pre-note” and your check will be mailed to your mailing or

local address of record during the pre-note process. Once direct deposit becomes active, your pay stub can be viewed and printed through

Banner Self Service.

___________________________________________________________________________________________

Primary Account (Required): The amount of deposit to the Primary Account is your net pay less any direct

deposit to the secondary account(s) listed below:

Bank Name: ___________________________________ [ ] Checking OR ⁫ [ ]Savings

(attach voided check or other bank info )

Bank Routing Number: ___ ___ ___ ___ ___ ___ ___ ___ ___ Account Number: ___________________________

(MUST be 9 digits)

______________________________________________________________________________________________

Secondary Account for Deposit (Optional):

Amount to be deposited each pay period: $ _____________ OR PERCENT OF NET PAY: ________ %

Bank Name: _______________________________________ [ ] Checking OR ⁫[ ]Savings ⁫

(attach voided check or other bank info )

Bank Routing Number: ___ ___ ___ ___ ___ ___ ___ ___ ___ Account Number: ___________________________

(MUST be 9 digits)

STAFF & FACULTY ONLY: I AUTHORIZE IIT TO DEPOSIT ALL ACCOUNTS PAYABLE EXPENSE

REIMBURSEMENTS BECOMING DUE AND OWING TO ME INTO THE PRIMARY ACCOUNT SHOWN ABOVE.

PLEASE INITIAL

I hereby authorize Illinois Institute of Technology, hereafter called IIT, to initiate credit entries and to initiate, if necessary debit

entries and adjustments for any credit entries in error to my account(s) indicated above. Further, I understand that it is my

responsibility to verify that payments have been credited to my account(s) and that the University (IIT) assumes no liability for

overdrafts for any reason. I understand that in the event my financial institution(s) (BANK) is/are not able to deposit any electronic

transfer into my account(s) due to any action I take, the University (IIT) cannot issue the funds to me until the funds are returned to

the University (IIT) by the financial Institution(s) (BANK).

I understand this authorization will override any previous authorization and will remain in effect until revoked by my written

request. I understand that I must immediately notify Payroll Services before I close any/all account(s) listed above while this

authorization is in effect.

Send completed form to: Illinois Institute of Technology Payroll Dept, 3424 S. State, Tech Central 4B9-1, Chicago, IL 60616

Signature: __________________________________________ Date: _____________________________________

IIT DDF AUTH FORM 102012