Fillable Printable Direct Deposit Authorization - University of South Florida

Direct Deposit Authorization - University of South Florida

Direct Deposit Authorization

Division of Human Resources

Phone (813)974-7955 / Fax (813)974-5084 / SVC 0077

Human Resources / Payroll

Questions: (813) 974-7955 Rev. 05/2013

PLEASE read and carefully follow instructions.

This form will start or change direct deposits for all payroll payments received from the University of South Florida. Your

direct deposit can only be sent to one account at one financial institution. Completed direct deposit forms may be faxed to

Payroll at (813) 974-5084 or mailed to 4202 E. Fowler Avenue, SVC2172, Tampa, Florida 33620-6980. You may also submit

the form in person to Human Resources (SVC2172) or Payroll (SVC0077).

PLEASE PRINT CLEARLY

Last Name:

First Name:

Address:

GEMS Employee ID #:

Campus / Department:

Work Phone #:

Home Phone #:

Requested Action: Start Change Account Type: Checking Savings

Attachments Required:

 For Checking Accounts attach a voided check or a copy of a voided check.

 For Savings Account contact your Financial Institution to obtain an official authorization form.

Document attached must clearly indicate your account number and your financial institution’s routing number.

Deposit Slips will not be accepted.

AGREEMENT

My signature below authorizes and requests the University of South Florida (USF) to initiate credit entries and, if necessary,

debit entries and adjustments for any credit entries in error, to my account at the financial institution named. This direct

deposit is to remain in effect until withdrawn by (a) me in writing, with sufficient notice to USF to allow adequate time to

effect termination; (b) my death or legal incapacity; (c) the financial institution or (d) USF. Otherwise, it will purge six (6)

months after my last wage payment.

My signature also attests that (1) the full amount of my direct deposit is not being forwarded from the financial institution

listed above to a bank in another country; and (2) if at any point I establish a standing order for my receiving bank to

forward the full amount of my direct deposit to a bank in another country, I will inform USF Payroll immediately- (813) 974-

7955 or SVC0077.

NOTE: If you wish to stop your direct deposit, please contact the Payroll Office immediately at (813)974-7955. Please make

sure your direct deposit has stopped before closing your account. Otherwise, the funds will be returned to USF which will

cause a 7 to 10 day delay before you will receive your salary payment.

THIS FORM MUST BE SIGNED AND DATED

Employee Signature:

Date:

If you are not the account owner, the owner must also sign here:

Print Name:

Signature:

Date: