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.
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