FA Direct Deposit Request Form

FA Direct Deposit
Request Form
CHECK ONE:
 START
 CHANGE
Direct Deposit
TBCC ID or SSN
Last Name
Street Address
 STOP
Bank or Account Number
Direct Deposit
First Name
M.I.
Phone:
City
State
Zip
 Check here if this is a change of address
Bank Name
Bank Account Number
Bank Address
Bank Routing Number (9 digits)
STAPLE VOIDED CHECK HERE (Counter checks NOT accepted)
Joe Smith
1234 Anystreet Ct
Anycity, AA 12345
1234
Pay to the order of
_____________________________________________
_____________________________________________________ Dollars
Bank Anywhere
|:123456789|: 123456789123 ||▪1234
Bank Routing
Number
Bank Account
Number
______________
Check Number
(Do not use)
BE SURE TO VERIFY YOUR DEPOSIT HAS BEEN COMPLETED BEFORE ACCESSING FUNDS .
TBCC is not responsible for returned check charges. Please check with your bank to make sure it is a member of the
Automated Clearing House (ACH) network. Failure to do so may delay processing of your refund.
Dormant accounts will be inactivated after 2 years. If your account has been inactivated, a new request form will be required.
I hereby authorize Tillamook Bay Community College (TBCC) and my financial institution to transfer the full amount of my excess
financial aid funds into my bank account as indicate above. This authorization will remain in effect until canceled by me in writing. I
also authorize TBCC to apply my Title IV financial aid fund towards institutional charges incurred by me beyond tuition and fees, such
as bookstore and other charges. If necessary, I authorize adjustments to any deposits TBCC may have processed in error to my
account and authorize the bank, to credit and/or debit the same to such account.
If TBCC deposits funds to my account which I am not entitle to receive, I authorize TBCC to direct the financial institution to return the
funds deposited in error as explained under Section 2.5, Subsection 2.5.a of the NACHA Operating Rules.
I agree to notify TBCC’s Business Office immediately and in writing of any changes to information pertaining to my checking or saving
account or to terminate this authorization, and to notify Student Services of any change of address. I understand improper notification
or incorrect information may result in a processing delay of my refund.
Student Signature
Date
BRING OR SEND YOUR
COMPLETED FORM TO:
TBCC – Business Office
4301 Third Street, Tillamook, OR 97141
Tillamook Bay Community College is an equal opportunity educator and employer.