Direct Deposit Authorization Form Place voided check here

Direct Deposit Authorization Form
Form Purpose: To start, change or stop direct deposit for payments received by you from Florida A&M University. Employees
are limited to three direct deposit accounts. If you choose to have more than one account, you are required to complete this
form for each account. Direct deposit can be managed by the employee through Self Service in the iRattler PeopleSoft system
or by completing this form and submitting it the Payroll Office. This form must be completed in its entirety and signed in order
to be processed.
Employee ID or SSN
Employee Full Name
Date of Birth
Phone Number
Select Action Type
Direct Deposit Action (Select Start,
Account Type (Select Checking or
Stop, or Change)
Distribution Type (Select Amount,
Amount/Percent (Flat dollar amount
Balance, or Percent)
or Percentage amount)
ACH Routing Number
Account Number
Please attach a voided check with your name printed on it. In lieu of a check, you may submit a bank issued or financial
institution direct deposit form or written statement. Please do not provide a deposit slip as the routing number differs
from the direct deposit routing number.
I, the undersigned, hereby authorize and request Florida A&M University to initiate credit entries and, if necessary, a debit entry
in accordance with NACHA rules reversing a credit entry made in error, to my account at the named financial institution. This
direct deposit authorization will remain in effect until withdrawn by: (a) me, either in writing by submitting this form
requesting a change; (b) my death or legal incapacity; (c) the financial institution; or (d) Florida A&M University. Direct deposit
data is inactivated one year after separation of employment. Please make sure your direct deposit has stopped before closing
your account. Otherwise, the funds will be returned to Florida A&M University and may cause a seven to ten day delay in
receiving your funds. Florida A&M University is not liable for any incorrect information submitted by the employee on this form
(e.g.: account number, employee identification number etc). It is the employee's responsibility to verify the deposit of his/her
salary/wages prior to writing checks on accounts. My signature below signifies acceptance of the terms and conditions stated
Signature _________________________________________
Date _______________________________________________
Place voided check here