Alabama Direct Deposit Form 3

The University of Alabama - Agreement for Direct Deposit
(This form allows split direct deposits to three accounts.)
Please print and sign.
Employee Name:
CWID:
SS#:
Contact Phone #:
I hereby authorize The University of Alabama to direct deposit (credit) my net pay to the account(s) and financial institution(s)
listed below. The University of Alabama may make such deposition each payday, until I terminate this agreement in writing, in
which case such notification shall become effective following receipt by The University of Alabama and a reasonable
opportunity to act on it.
In the event that funds are erroneously deposited into my account(s) I authorize the University of Alabama or the depository
institution to debit my account(s) for the purpose of correcting the error.
If I am a new employee, I understand there will be a delay in the start of direct deposit until my account information is verified
(the verification process normally takes one pay period). I understand it is my responsibility to verify my account balance prior
to drawing on my account.
Please Deposit My Net Pay to the Following Account(s). Please attach a voided check for each account.
Note: Voided checks are not required for savings accounts.
Account # 1
(check one) New Employee
Add
Change Amount
Cancel
(check one) Checking
Savings
Bank/Financial Institution Name:
Routing #:
Account #:
Amount:
Note: The amount in one account must indicate remaining balance.
Account # 2
(check one) New Employee
Add
Change Amount
Cancel
(Partial $ Amount or Balance)
(check one) Checking
Savings
Bank/Financial Institution Name:
Routing #:
Account #:
Amount:
Note: The amount in one account must indicate remaining balance.
Account # 3
(check one) New Employee
Add
Change Amount
Cancel
(Partial $ Amount or Balance)
(check one) Checking
Savings
Bank/Financial Institution Name:
Routing #:
Account #:
Amount:
Note: The amount in one account must indicate remaining balance.
Employee Signature:
(Partial $ Amount or Balance)
Date:
Please return form to:
HR Service Center – G-69 Rose
Box 870128
(205) 348-7732
Revised 09/2007