Fillable Employee Direct Deposit Form - Kentucky State University printable pdf download

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KENTUCKY STATE UNIVERSITY

DIRECT DEPOSIT AUTHORIZATION

FOR EMPLOYEE REIMBURSEMENTS

Division of Finance and

Business Affairs

400 East Main Street

Frankfort, Kentucky 40601

DIRECTIONS

To sign up for direct deposit of your employee reimbursement, complete this direct deposit authorization form and attach a voided

check for checking accounts or share draft accounts. For savings accounts, please contact your financial institution for the appropriate

routing number. The routing number shown on your savings account deposit slip may not be a correct routing number for direct deposit

of funds. After you submit this form to the Purchasing Department, all travel reimbursements and other non-payroll disbursements will

be directly deposited into your bank account. If you close your bank account, please notify us of the change immediately. When

deposits are made to your bank account, notification e-mails are sent to your University e-mail address stating the amount and effective

date of the deposit.

Do not write any checks using your credit balance until you confirm that funds are available in your bank account.

If you elect to use the same account used for your payroll direct deposits, please indicate this preference below.

To fill out the form online, select a field and type. Print the form to add your signature.

SECTION A. Employee information

Name (last, first, middle initial)

CWID or SSN

Employee Campus Address and phone number

University-assigned e-mail

@kysu.edu

address

Name of bank

Bank address (city, state, and zip code)

Bank routing number

Account number

Account type (check one)

(9-digit number in the bottom left corner of check)

❑

checking

savings

SECTION B. Authorization

I hereby request that Kentucky State University (check the appropriate selection):

❑ START depositing my travel reimbursement and non-payroll related disbursements into my checking or savings bank account

according to the account information I provided in the previous section.

❑ EXISTING use my existing payroll direct deposit account to deposit my travel reimbursement and non-payroll related

disbursements into my checking or savings bank account.

❑ STOP depositing my travel reimbursement and non-payroll related disbursements into my checking or savings bank account

according to the account information.

❑ CHANGE my direct deposit bank number and/or account number according to the information I provided in the previous

section.

SECTION C. Certification

By signing this form, I certify that the information I provided is true and correct. I understand that the earliest I can expect my account to be credited

is the effective date listed on the e-mail notification sent by Kentucky State University, and that the University is authorized to reverse a deposit from

my account in the event of an error.

Employee signature

Date

ATTACH VOIDED CHECK (CHECKING ACCOUNT)

DEPOSIT SLIP (SAVINGS ACCOUNT)

HERE