Michigan State University Direct Deposit Form printable pdf download

Michigan State University

Direct Deposit Form

I (we) authorize Michigan State University to deposit excess Student Account or Fellowship stipend funds to the

account at the institution indicated below and to initiate a withdrawal from the account to adjust for deposit entries

made in error. I understand that if I change banks it is my responsibility to update my banking information. I also

understand in order to process my direct deposit, MSU will exchange key banking information including social

security number through a secure electronic transmission.

I will not transfer the entire amount of my direct deposit from a United States financial institution to a financial

institution in another country or to a foreign financial institution that has a branch office in the United States prior to

contacting the Student Billing and Receivables Office.

Please note a

Change in Account:

New Account for:

Last Name _____________________________________________

First Name _____________________________________________

Student PID ____________________________________________

Phone Number __________________________________________

Email __________________________________________________

Account Type ___________________________________________

Bank Name _____________________________________________

Bank Routing Number _____________________________________

Bank Account Number _____________________________________

Account Holder's Name ____________________________________

Account Holders SS# ______________________________________

This authority is to remain in full force and effect until MSU receives written notification from the

student or account holder or the account is inactive for one year. PLEASE ATTACH A VOIDED

CHECK WITH IMPRINTED NAME.

________________________________________________

Student Signature/Date

________________________________________________

Account Holder’s Signature/Date

MAIL TO:

Student Billing & Receivables

DD Program

Michigan State University

Hannah Administration Building

426 Auditorium Rd Rm 140

East Lansing, MI 48824

Rev. 1/2012

Michigan State University Direct Deposit Form