VENDOR DIRECT DEPOSIT AUTHORIZATION FORM
INSTRUCTIONS
Controller’s Office
“Submit”
Please click the
button at the bottom of this form once complete.
For further instructions and explanations, please refer to second sheet of this form.
S
I – General Information
ECTION
1. Name (First, MI, Last):
2. Tax ID Number:
3. Mailing Address:
4. Vendor Contact Person: _________________________________ 5. Phone Number: __________________
6. E-Mail:
(Electronic Notification will be sent to email address listed for Vendor payments)
S
II –Banking Information
ECTION
TYPE OF TRANSACTION:
TYPE OF ACCOUNT:
Routing Number (9 digits)
Checking
Savings
Start
Change
Cancel
Account Number
FINANCIAL INSTITUTION
CITY, STATE, ZIP CODE
Section III – University of the Pacific Internal Use Only
Banner Vendor ID#: ________________
Note to Processor: verify all Banner information before processing form. When setting up a new bank, please pre-note.
Submit
Page 1 of 2
Revised: 8/13/14