Automatic Deposit Transmittal Form - Langston University printable pdf download

Automatic Deposit Transmittal Form - Langston University

Official Use Only

Langston University

AUTOMATIC DEPOSIT TRANSMITTAL

This form is to be used by State and Higher Education Employees in communicating their direct deposit information.

Social Security

Name:

Number:

I hereby authorize the Sta

ADD

PAYROLL

(Deposit my payroll warrant in my account as indicated below)

REMOVE

PAYROLL

(I understand that by terminating Direct Deposit for Payroll this will automatically terminate travel

and spending from my direct deposit)

If monies to which I am not entitled are deposited to my account, I authorize the State of Oklahoma to direct the financial institution to

return said funds. I understand the payroll date and frequency of payment currently being utilized by my employing agency will not be

affected by my decision to use Electronic Fund Transfer.

ONLY ONE ACCOUNT MAY BE USED FOR DIRECT DEPOSIT

CHECKING

SAVINGS

PAYCARD

WITHIN THE STATE SYSTEM

GGG

Financial Institution

Name (Your Bank):

City

State:

This authority is to remain in full force and effect until: (A) I give my employer written notice using this form (OPM-73) to terminate this

direct deposit agreement. (B) I fail to utilize payroll direct deposit for 365 days, at which time this agreement will expire. (C) The event

of my death, at which time this agreement expires immediately, upon notification. This information is provided by me to facilitate my

personal banking needs and shall be considered personal and held in confidence

Home Mailing

Address:

State:

City:

ZIP

Home Telephone

Work Telephone

Number:

Employing Agency:

Signature:

Date:

I understand that while a change of enrollment is in process I may, in fact, receive a warrant instead of an electronic transfer.

If this is an initial enrollment or bank routing and/or account number change please attach a voided check or an official document

A detailed list of all transaction fees associated with the Key2Prepaid card can be found at Please check with your financial

institution for possible applicable paycard fees.

A signed form must be on file.

Please submit the completed form to the address below.

Langston University

Office of Human Resources

Page Hall, Room 222

Langston, OK 73050

(405) 466-2985

ATTACH CHECK HERE

Automatic Deposit Transmittal Form - Langston University

Related Articles

Related forms

Related Categories