Fillable Printable Payroll Direct Deposit Authorization Form - University of Colorado

Payroll Direct Deposit Authorization Form - University of Colorado

Bank N ame:

Bank Address:

Routing# (9 digit s) Ac count #

Requested amount for this account: (select one)

Bank N ame:

Routing# (9 digit s) Ac count #

Requested amount for this account: (select one)

Bank N ame:

Bank Address:

Routing# (9 digit s) Ac count #

Date:

COMPLE T E IN INK - DO NO T FAX OR EMAIL

Payroll Direct Deposit Authorization Form

Acc ount #1

Contact Phone (Campus # Preferred)

Complete the account designation boxes (up to 3) including routing and account numbers, and attach the following required documentation:

 Che cking Account: Attach a voided check.

 Savings Account: Attach documentation from financial institution.

 Money Market Account: This is a type of checking account. Attach documentation from financial institution to provide correct routing and

account numbers.

The routing number is a 9-digit number that appears at the bottom left of your check or deposit slip between the markings l: :l. It cannot begin with a

"5". If you are not sure which number to use, contact your financial institution for assistance.

Home Department / Campus

NOTE: Requests must allow sufficient time for processing and bank pre-notification, and m ay not be effective for your next pay date. Late requests may

result in a warrant (check) being issued (for new employee) or deposit to an already established account (for continuing employee). We suggest leav ing

your old account open until deposit to your new account has occurred.

Empl oyee m ay select up to three separate ac counts. You w ill receive a detai led Advice of Deposit.

(Attach voided check)

(Attach financial institution

documentation)

(Attach financial institution

documentation)

IMPORTANT:

Enter all

financial institutions to which you ar e depositing funds, a nd attach documentation for all accounts, even i f only one

is c hanging. Enter the lowes t % or $ amount firs t a nd the hi ghe st % or $ amount last. This form overrides (replaces) all pr i or designations.

( ) - Pay Frequency (Required)

Employee ID (Preferred) or Soc. Sec. # Employee Name (Last Name, First Name)

(Please Type or Print)

DO NOT FAX OR EMAIL

Mai l ORI G INAL FORM to CU Em ployee Services, 1800 Grant Street, Suite 400, Denver, CO 80203

Account Holder Signa ture :

Revised: 01/15/14

Authorization Agreement: I hereby authorize the University of Colorado to deposit my paycheck each payday directly into the account(s) named above. This authority will remain

in force until I have given written notice that I am terminating it, or until my employer has notified me that this deposit service has been discontinued. I understand that I must give

advance notice to allow reasonable time for my instructions to be executed. If an incorrect deposit should be made into my account(s), I authorize my bank(s) and the University of

Colorado to make the appropr iate adjustment( s) .

Employee Signature:

(if other than employee)

Acc ount #2

(Attach voided check)

(Attach financial institution

documentation)

(Attach financial institution

documentation)

(Attach financial institution

documentation)

Bank Address:

(Attach financial institution

documentation)

Acc ount #3

(Attach voided check)

% Net Pay:

Specific $ Amount:

Entire Balance

Account Type:

% Net Pay:

Specific $ Amount:

Remaining Balance

1800 Grant Street, Suite 400 t 303 860 4200

400 UCA 1 855 216 7740 (toll free)

Denver, CO 80203 pbs

@cu.edu

Checking

Savings Money Ma rket

Checking

Savings

Money Ma rket

Checking

Savings

Money Ma rket

Bi-Weekly Monthly