DIRECT DEPOSIT AUTHORIZATION FORM Date:

DIRECT DEPOSIT AUTHORIZATION FORM
To authorize direct deposit of your pay, please:
1. Read and sign the authorization statement below.
2. Complete all required information.
3. Attach a voided check which provides the bank routing and account number or an authorization on bank
letterhead that contains this information.
The Following Information Must Be Provided In Full
(PLEASE PRINT CLEARLY)
NAME:
(First)
(MI)
□
BANNER ID:
(Last)
□
STUDENT
FACULTY/STAFF
FOR YOUR SAFETY, WE USE A PRE-NOTE SYSTEM TO VERIFY YOUR ACCOUNT INFO.
YOUR FIRST PAYROLL WILL BE A LIVE CHECK. AFTER THAT YOUR DIRECT DEPOSIT WILL BE IN EFFECT.
FINANCIAL INSTITUTION:
□ CHECKING
□ NEW □
□ SAVINGS DOLLAR AMOUNT
CHANGE □ CANCEL
or
or PERCENTAGE
FINANCIAL INSTITUTION:
□ CHECKING or □ sAVINGS DOLLAR AMOUNT
□ NEW □ CHANGE □ CANCEL
or PERCENTAGE
Authorization Statement
I hereby authorize Utica College to deposit my payroll/work-study earnings directly into my bank account listed above and to obtain
the return of any payroll amount erroneously credited to that account. I understand that processing of this request may require up to
two pay periods from the receipt of this authorization and that this authorization will continue for the duration of my employment or
until the Office of Human Resources receives a request for cancellation with my signature. I further understand that I will be able to
access an account of my earnings on BannerWeb at http://www.utica.edu showing what I have earned for each pay period.
Utica College is not responsible for bank errors or delays by the bank
in crediting individual accounts.
Signature:
cbs 10/2011
Date:
PLEASE RETURN THIS FORM TO:
OFFICE OF HUMAN RESOURCES