Payroll Direct Deposit Authorization Form For further instructions and explanations, please refer to the other side of this form. Contact Accounts Payable (x5497) to setup expense reimbursement direct deposit. SCU ID Number Name TYPE OF TRANSACTION: TYPE OF ACCOUNT: O Start O Add O Change O Cancel O Checking Routing Numbers - Code O Savings For Add/Change: 1st % or $ _______ ACCOUNT NUMBER FINANCIAL INSTITUTION TYPE OF TRANSACTION: O Start O Add O Change O Cancel CITY, STATE, ZIP CODE TYPE OF ACCOUNT: O Checking Routing Numbers - Code O Savings For Add/Change: 2nd % or $ _______ ACCOUNT NUMBER FINANCIAL INSTITUTION TYPE OF TRANSACTION: O Start O Add O Change O Cancel For Add/Change: 3rd % or $ ________ CITY, STATE, ZIP CODE TYPE OF ACCOUNT: O Checking Routing Numbers - Code O Savings _______________ ACCOUNT NUMBER FINANCIAL INSTITUTION CITY, STATE, ZIP CODE STAPLE VOIDED PERSONAL CHECK FOR EACH ACCOUNT. Additional instructions: I hereby authorize Santa Clara University to initiate credits (and/or corrections to the previous credits) to my account at the institutions listed above. This authority is to remain in full force and in effect until I revoke it in writing giving the SCU Human Resources Department a reasonable opportunity to act on it, or upon termination of my employment. The information on this form replaces any information on previously completed forms. Employee Signature Phone Number Date Note to Human Resource Representative - verify all information before accepting form, make sure form is signed and a phone number is listed. When setting up account information, please verify with employee’s bank that you have correct account number and correct routing number. Bank of America California – 121000358 General Instructions on filing out the Payroll Direct Deposit Authorization Form Step 1. For all transactions, please fill out the form with your Name and Employee Identification number (if known). Step 2. Select the type of transaction you wish to do and follow the instructions as they apply. Checking New Account Type of Transaction Changes Savings Mark the circle for Start under type of transaction and Checking under type of Account. Please staple a voided personal check to the front of the form Mark the circle for Start under type of transaction and Savings under type of account. Please have documentation for that account available, for verification. Multiple Accounts You may direct deposit your earnings into a maximum of three accounts. Please follow the steps above as applicable to each account. See Allocation of Funds for additional information Additional Accounts Mark the circle for Add to increase the number of accounts that you already have set up and follow the step(s) above for a new checking and/or savings accounts I.e. adding a savings account, when you already have a checking account set up. Allocation of Funds Mark the circle for Change. Indicate the new fund allocation. Funds can be allocated using a flat amount or a percentage. To determine which account is first, a flat amount or a percentage amount less than 100%, will be listed as the first account or second account. Any amount that is considered the “remainder” will be listed as the second or third account Canceling One Account Cancellation Canceling Direct Deposit Mark the circle for Cancel to stop direct deposit into the existing Account to be cancelled only. List the account(s) to be cancelled as well as the account(s) to remain active. Mark the circle for Cancel to stop direct deposit into all existing Accounts listing all the accounts that you have set up. Step 3. Once the form has been filled out, sign; date the bottom and write a phone number where you can be reached for further clarification, if needed. Submit form to Human Resources. Contact Accounts Payable (x5497) to setup expense reimbursement direct deposit. All Direct Deposit accounts take a minimum of 2 pay periods to start. The first pay period is considered the Pre-notification which is the process for verifying the information provided on the direct deposit form with the bank(s) information. This information is sent with a $0.00 amount. If the prenotification is successful, then the Direct Deposit will be effective on the next payday. If the pre-note is not successful, we will recheck the information, and try again the following pay period.
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