Fillable Printable Direct Deposit Form - Middle Georgia State College

Direct Deposit Form - Middle Georgia State College

X:\Forms\Direct Deposit Form 7-8-15.docx/mmr

M I D D L E G E O R G I A S T A T E U N I V E R S I T Y

A u t h o r i z a t i o n A g r e e m e n t f o r D i r e c t D e p o s i t

Direct Deposit Form

Employee Name: Employee ID and/or Social Security Number:

I hereby authorize MIDDLE GEORGIA STATE UNIVERSITY, hereinafter called the

University, to initiate credit entries and to initiate, if necessary, debt entries and adjustments

for any credit entries in error to my account(s) indicated below and the depository(s) named

below, hereinafter called DEPOSITORY, to credit and/or debit the same to such account(s).

Important Facts about Direct Deposit

An employee can have his/her check deposited into multiple accounts. One account must be

designated as the “balance account, but the other accounts can be split based on dollar

amounts or percentages.

A check marked “VOID” should be submitted with this authorization form. A deposit slip is

acceptable ONLY for direct deposit into a savings account.

The employee’s account will be pre-noted the first pay cycle after the authorization has been

received. This means that no money is actually sent to the employee’s bank, just the name

and account number to assure that no mistakes have been made in coding. The next pay cycle

the employee’s check is direct deposited.

Employees who wish to change or end direct deposit must do so via HR Self Service.

Direct Deposit #1

Effective Date:

Bank/Credit Union:

FOR OFFICE USE ONLY

Excess? Partial Allowed?

9 digit Transit Routing Number:

Account Number:

CHOOSE ONE – PERCENT OR DOLLAR

Percent of Net Pay:

Dollar Amount:

Account Type: Checking Saving

Direct Deposit #2

Effective Date:

Bank/Credit Union:

FOR OFFICE USE ONLY

Excess? Partial Allowed?

9 digit Transit Routing Number:

Account Number:

CHOOSE ONE – PERCENT OR DOLLAR

Percent of Net Pay:

Dollar Amount:

Account Type: Checking Saving

X:\Forms\Direct Deposit Form 7-8-15.docx/mmr

Direct Deposit #3

Effective Date:

Bank/Credit Union:

FOR OFFICE USE ONLY

Excess? Partial Allowed?

9 Digit Transit Routing Number:

Account Number:

CHOOSE ONE – PERCENT OR DOLLAR

Percent of Net Pay:

Dollar Amount:

Account Type: Checking Saving

This authority is to remain in full force and effect until the University has received written

notification from me of its termination in such time and in such manner as to afford the

University and DEPOSITORY(S) a reasonable opportunity to act on it.

I am responsible for verifying all deposits made with my bank(s) before I issue check

or debits against my account.

Signature: Date:

PLEASE ATTACH A VOIDED CHECK FOR CHECKING ACCOUNT(S) TO INSURE PROPER

CREDIT. FOR SAVINGS ACCOUNTS, YOU MUST COMPLETE THIS FORM CORRECTLY TO

INSURE PROPER CREDIT. IF YOU HAVE ANY QUESTIONS REGARDING YOUR ROUTING

NUMBER(S) AND/OR ACCOUNT NUMBER(S), PLEASE CONTACT YOUR BANK(S)/CREDIT

UNION.

TAPE VOIDED CHECK HERE