Direct Deposit Cancellation Form

Payroll Services

Employee Name: _____________________________________________________

Banner ID Number: ___________________________________

Please cancel direct deposit of my paycheck into the account(s) listed below.

Account #: ______________________________ Effective Date: ______________

_____________________________________

__________________

Employee Signature

Date

_________________________________

Contact Phone Number (if any questions)

PAYROLL SERVICES

P: 646-592-4320

F: 212-960-0887

payrollservices@yu.edu

Wilf Campus 500 West 185

Street, Belfer Hall, New York NY 10033

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Parent category: Business