Pennsylvania Direct Deposit Form 1

DIRECT DEPOSIT AUTHORIZATION FORM
How Direct Deposit works –
The Pennsylvania State System of Higher Education notifies your financial institution electronically of the funds to be
deposited on your behalf. Your financial institution records this transaction into an account of your choice, creating
immediate access on the day of deposit. You receive an earnings statement documenting this payment. Only one deposit
can be made to one account at each institution.
9 It’s convenient -saves you a trip to the bank.
9 It’s faster - most banks post the funds to your account at the beginning of the day’s business on payday
allowing immediate access
9 It’s safer – Direct Deposit eliminates the worry of a lost or stolen paycheck
9 It’s confidential – funds are automatically processed and you can instruct the bank to apply them to your
savings or checking account
Name _____________________________________________________ Personnel Number ______________________
I hereby authorize the Pennsylvania State System of Higher Education to (circle one) Start / Change / Stop total bi-weekly payroll
deduction to the Financial Institution shown below. You may designate any bank, savings and loan association, or credit union in the U.S. that
(1) is a member of the Federal Reserve System and (2) accepts electronic funds transfer. Payroll will notify you if the institution you choose does
not qualify.
Financial Institution’s Name ______________________________________________________ (for net pay deposit)
Transit Routing Number ________________________________________________________
Account Number _______________________________________________________________
Type of Account _______________________________________________________________ (Checking or Savings)
2nd Financial Institution’s Name __________________________________________________
Transit Routing Number _________________________________________________________
Account Number #2 ____________________________________________________________
Type of Account _______________________________________________________________ (Checking or Savings)
Deduction Amount _____________________________________________________________
Effective with pay date of _______________________________________________________
I have an established account at the Financial Institution indicated above, and authorize the Pennsylvania State System of Higher Education to
initiate credit entries and to initiate debit entries and adjustments for any credit entries in error to my (our) account(s) indicated above.
**I have provided a copy of a voided check (see attached) solely for the purpose of verifying my account
number and the Financial Institution's routing number. **
My authorization will remain in effect until revoked by me in writing or I terminate my employment with the Pennsylvania State System of
Higher Education.
Signature ____________________________________________________________ Date _______________________
Co-Signature (If Joint Account)_______________________________________________________________________