Fillable Printable Request for Direct Deposit of Net Pay - The University of Georgia

Request for Direct Deposit of Net Pay - The University of Georgia

Payroll Department

Request for Direct Deposit of Net Pay

••• All elds must be completed •••

I hereby authorize the University of Georgia to deposit my net pay and any reimbursements into my account at the above named

bank. The University is also authorized to adjust any over/under deposit which it has caused to be made into my account. This

authorization will remain in effect until I cancel or supersede it in writing to the University of Georgia Payroll Department. Due to

electronic funds transfer prenotication requirements, I understand this request may not be effective until the second payday after it is

received in the Payroll Department (this time delay also applies when changing banks). I also understand this election will include

travel and most other reimbursements the University makes to me.

It is important to keep your bank information updated. Changes made to the bank account information in the Payroll system do not

update any other bank information the University may have on le for you such as direct deposit for your student account. It is your

responsibility to update any bank account changes with each of these departments separately.

Name (Last, rst, middle initial)

Name of nancial institution (US only)

Bank routing number (9-digit # prior to your acct # on your check)

UGAID (81X#)

Exact name on account

Account number

Checking

Savings

• • • You must attach a voided check here • • •

Signature

Date Department

Revised 07/02/2012

http://www.busn.uga.edu/forms/f105.pdf

I understand that should I terminate my employment and later return to work at the University, my direct deposit

authorization will continue in effect unless I have submitted a new form or notied the Payroll Department in

writing of my desire to cancel my direct deposit.

Email Address

Please return this form and any attachments to:

Payroll Department

University of Georgia

Room 205

Business Services Building

Athens, Ga, 30602-4215

fax: 706-542-6779

Please tape check here.

(Do not staple)

Date of Birth