Alabama Direct Deposit Form 2

The University of South Alabama
Purchasing Department
Authorization for Electronic Direct Deposit
Select One:
New
Account Type:
Change
Checking
Savings
*If the University already has your information and there have been no account changes, this form is not required.
Vendor Information
Name (printed):
USA Vendor (J) Number:
Contact Name:
Federal ID Number:
Street Address:
City
State
Zip Code
Phone Number:
E-mail Address (For notification of direct deposit):
Financial Institution Information
Name:
Street Address:
City
State
Zip Code
Exact Depositor Account Name:
Nine-Digit Routing Transit Number:
Account Number:
I certify that the information provided on this form is correct and understand that I am responsible, upon receiving USA notification of deposit,
for verifying with my bank that my account has been credited. I understand that expenditures made from my account without such verification
will be made at my own risk. I agree to promptly notify the USA Purchasing and Accounts Payable Departments of changes in name, address,
and/or account status. I authorize the financial institution named above to process the credit entries initiated by USA. I understand that that this
authorization remains in full force and effect while I am a vendor for USA unless USA receives my timely written request to terminate or unless
USA notifies me that EDD or my participation in EDD is to be terminated.
Authorized Signature:
Date:
*If we are making deposits on your behalf into a U.S. banking institution and then the entire payment is transferred to an international
bank, please contact the USA Accounts Payable department @ (251) 460-6191. Further information can be obtained at www.nacha.org
*******ATTACH VOIDED CHECK HERE*******
Deposit Slips Are Not Accepted
Please Complete and Return to the following:
The University of South Alabama
Purchasing Department
307 University Blvd., Room AD-245
Mobile, AL 36688-0002
Fax: (251) 414-8291
Revised 5/31/12