Fillable Employee Direct Deposit Authorization Form printable pdf download

Employee Direct Deposit Authorization

Domestic Payments Only – No International Direct Deposit

Change

New

Cancel

Type of Transaction (check one):

Last Name

First Name

NSU ID #

Middle Name

Phone number

E-Mail Address

Department

Location

Direct deposit is available for all employees and will be applied to employee reimbursements (including student employees),

student refunds issued by Accounts Payable (AP) and for paychecks (issued by Payroll). Only one form is required to be

completed. You must indicate below how you want each type of check deposited.

Employee Reimbursements (AP): Deposits can only be made to ONE CHECKING account. Select the box below indicating the

account the entire payment should be deposited to. If no selection is made, funds will be deposited into the PRIMARY ACCOUNT.

NOTE: If the employee is also a student, in addition to expense reimbursement, all student account refunds will be issued via

ACH to this checking account.

Payroll: Direct Deposit of your payroll check can be made into three (3) accounts. The first paycheck you receive after your form

has been received and processed will be a live paycheck. Once your account(s) have been verified by the financial institution you

provided, your subsequent pays will be directly deposited.

• For one account only, complete only Box 1 (PRIMARY ACCOUNT) if you want 100% of your pay to go to this account.

• For two(2) or more accounts, complete Box 2 and/or Box 3 for each account into which you want to deposit a specific amount.

Use even dollar amounts only. Complete Box 1 for the account into which you would like the balance of your check deposited.

Changing or closing an account: It is IMPERATIVE that you notify Payroll prior to closing an account or if you have been

notified of any changes in account number and the routing/transit number. Note: If you change, add, or close an account, you

must submit a new form reflecting this change. Failure to notify Payroll could cause a delay in payment.

BANKING information: Attach a voided check to this form or contact your financial institution to provide you with printed

documentation of your account number and the routing/transit number to be used for ACH/Direct Deposit purposes.

Employee reimbursements (AP)

PRIMARY ACCOUNT

SELECT TYPE:

Savings

Checking

will be made to this account if no

other account is specified below.

Only one account can be selected

Name of Financial Institution: __________________________________________

for these payments. NOTE: If

employee is a student, any

Routing Number: __________________ Acct #: ___________________________

student account refunds will also

be made to this account.

ACCOUNT # 2

SELECT TYPE:

Checking

Savings

Amount: $ __________

Use this account for employee

reimbursements (AP) and

student account refunds.

Name of Financial Institution: __________________________________________

Routing Number: __________________ Acct #: ____________________________

Yes

Savings

ACCOUNT # 3

SELECT TYPE:

Checking

Use this account for employee

Amount: $ __________

reimbursements (AP) and

student account refunds.

Name of Financial Institution: __________________________________________

Yes

Routing Number: __________________ Acct #: ____________________________

Please sign, date and return this form providing the account number and the routing/transit number to the Payroll Department,

via interoffice mail (mail code: PAY), email (payroll@nova.edu) or fax to (954) 262-3997. By signing below, I am authorizing NSU

to initiate electronic credit entries and, if necessary, debit entries and adjustments for any credit entries made in error to my

account(s). This authorization remains in effect until NSU receives a written revised notification from me. It is my responsibility to

verify funds are available at my bank before making any transactions.

Additionally, by signing this form, I am confirming that the direct deposit is being made to a domestic financial institution and will

not be part of a back-to-back transaction to a foreign institution.

Signature

Date:

: _________________________________________________________

_______________________

Revised 04/13/2016

Employee Direct Deposit Authorization Form

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