Pennsylvania Direct Deposit Form 3

University of Pennsylvania
Payroll Department
310 Franklin Building
3451 Walnut Street
Philadelphia, PA 19104-6284
Phone (215) 898-6301 Fax (215) 573-2554
E-mail: payroll@pobox.upenn.edu
DIRECT DEPOSIT
The University is pleased to offer Direct Deposit to its employees. With Direct Deposit you have the convenience
of having your net pay automatically deposited on payday into either your checking or savings account at most
financial institutions.
Staple
Check or
Deposit
slip here.
How to Enroll
• Complete the Authorization Agreement for Direct Deposit and staple a voided blank check (for deposit into a
checking account) or a savings account deposit slip (Needs to have pre-printed account number on it) to the
form and forward to the Payroll Office.
• Allow approximately 2 to 3 weeks for Direct Deposit to take effect. When it becomes effective, you will receive
a blue non-negotiable pay stub instead of a pink paycheck. The pay stub lists gross pay, all deductions, and
the net pay deposited. NOTE: A credit union will take 6-8 to be approved with or with out a voided check.
• Direct Deposit is a joint responsibility between employer and employee. You should verify the posting of each
pay with your bank. Failure to do so could result in overdraft charges for which you could be liable.
• If a voided check or deposit slip is not with this form, Direct Deposit can take up to 6-8 to be approved.
How to Change Accounts and/or Banks
Complete the Authorization Agreement for Direct Deposit checking the appropriate boxes at the top and attach
either a voided blank check or a savings account deposit slip to form and forward it to the Payroll Office. Making
changes or closing your account without notifying the Payroll Office will result in a $25.00 charge.
• Changing banks may cause a temporary break from Direct Deposit. Salary payments will return to regular
payroll checks during this time.
How to Cancel
Complete the Authorization Agreement for Direct Deposit checking the box labeled "Stop Direct Deposit" and
forward it to the Payroll Office. (It is not necessary to provide bank information.)
• Do not close your account until Direct Deposit is terminated.
AUTHORIZATION AGREEMENT FOR DIRECT DEPOSIT
BEGIN DIRECT DEPOSIT
STOP DIRECT DEPOSIT
ACCOUNT NUMBER CHANGE (SAME BANK)
CHANGE OF BANK
I hereby authorize The University of Pennsylvania to initiate credits to the bank indicated below and to initiate, if necessary,
debit entries and adjustments for any credit entries made in error to the following account:
FULL BANK NAME:
BANK’S TRANSIT ROUTING NUMBER:
-
YOUR ACCOUNT NUMBER:
CHECKING
SAVINGS
NAME:
SOCIAL SECURITY NUMBER:
-
E MAIL ADDRESS:
UNIV. EXTENSION:
This authority is to remain in full force and effect until the University has received a written notification from me of its
termination in such time and in such manner as to afford the University a reasonable opportunity to act on said notification.
If the BANK sends me written notice of the BANK'S termination of this agreement, I will notify the University of the termination.
DATE:
SIGNATURE:
Direct Deposit Form April, 2003