Missouri Direct Deposit Form 3

University of Missouri
DIRECT DEPOSIT
Authorization and Order For Payroll Check Direct Deposit in Financial Institution
Employee ID Number
Effective Date
Employee Name (Last, First, Middle Initial)
Home Address (Street, City, State, Zip Code)
The Treasurer of University of Missouri is hereby authorized to deposit my pay into my account identified as and held at the financial
institution identified below, and I certify that such account exists.
This authorization shall remain in effect until I give written notification of any change to my financial institution and/or account
number. I have attached a blank voided check (for deposits to checking account) or deposit slip (for deposits to savings account)
solely for the purpose of verifying my account number and the financial institution's transit number. The voided check or savings
deposit form must include the employee's name preprinted on the form. If this is not the case the employee must sign the voided
check or savings deposit form to indicate that this is the account their University pay should be deposited into.
Please sign and date the form and return it to Human Resources. Please allow 10 - 14 days for this to become effective.
Date
Employee's Signature
TYPE OF ACCOUNT
CHECK ONE OF THE FOLLOWING:
TYPE OF ACCOUNT
Financial Institution Name
Send statement of earnings to my campus office
address at:
Checking
Send statement of earnings to my home/mailing
address. (NOTE: Do not check this option if you have
a campus office address )
Savings
Financial Institution Address
City
State
FOR PAYROLL DEPARTMENT USE ONLY
Transit Number
UM 32B (FEB 10) 2/17/10
Account Number
Zip