Faculty/staff Direct Deposit Authorization Agreement

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SWARTHMORE COLLEGE
FACULTY/STAFF DIRECT DEPOSIT AUTHORIZATION AGREEMENT
I hereby authorize Swarthmore College to initiate payroll or accounts payable credit entries (and, if necessary,
debit entries or adjustment for any entries in error) to my account(s) at the financial institution(s) indicated below.
This authorization is to remain in full effect until the College has received written termination notice from me in
such manner as to afford the College a reasonable time to act on it (at least two weeks before my next scheduled
payment). Please note, the College cannot send a direct deposit transaction to a foreign bank account.
TYPE OF REQUEST:
[
]
SET UP Direct Deposit (Complete Account information below)
[
]
CHANGE Direct Deposit (Complete Account information below)
[
]
TERMINATE Direct Deposit
[
]
DECLINE Direct Deposit of Expense Checks
___________________________________________________________________________________________
FIRST ACCOUNT
[
]
I want ALL of my paycheck and/or accounts payable payments deposited to the First Account, OR
[
]
I want $ ________________ from each paycheck deposited to this First Account, and the BALANCE
and/or accounts payable payments deposited to the Second Account.
NAME(S) ON ACCOUNT: _________________________________________________________________
ACCOUNT NUMBER: ____________________________________________________________________
TYPE OF ACCOUNT:
[
]
Checking
(Attach voided check to this form)
[
]
Savings
(Attach savings deposit slip to this form)
NAME OF BANK/CREDIT UNION: __________________________________________________________
CITY: _________________________________________
STATE: __________ ZIP: _____________
BANK ROUTING TRANSIT NUMBER: ___ ___ ___ ___ ___ ___ ___ ___ ___
SECOND ACCOUNT
NAME(S) ON ACCOUNT: _________________________________________________________________
ACCOUNT NUMBER: ____________________________________________________________________
TYPE OF ACCOUNT:
[
]
Checking
(Attach voided check to this form)
[
]
Savings
(Attach savings deposit slip to this form)
NAME OF BANK/CREDIT UNION: __________________________________________________________
CITY: _________________________________________
STATE: __________ ZIP: _____________
BANK ROUTING TRANSIT NUMBER: ___ ___ ___ ___ ___ ___ ___ ___ ___
NAME: (print) ___________________________________________ CAMPUS PHONE _________________
Banner ID # __________________________________ PAY SCHEDULE: [ ] Monthly [ ] Bi-Weekly
SIGNATURE: _________________________________________
DATE: _____________________

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