Direct Deposit Authorization Form - Drew Human Resources

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Direct Deposit Authorization Form
Name
Address
City
State
Zip
Please attach a voided check for the corresponding
account(s).
Please note that it may take up to two (2) payroll cycles
for direct deposit to take effect.
I would like my live check(s) to be:
Mailed to address above
Held at Payroll
OR
Office for pick-up
Primary
____________
___________
____________
Checking
Savings
OR
Bank
Routing #
Account #
(Circle One)
____________
___________
____________
Checking
Savings
OR
Deposit 2
Bank
Routing #
Account #
(Circle One)
Amount:
$ ___________
____________
___________
____________
Checking
Savings
OR
Bank
Routing #
Account #
Deposit
(Circle One)
3
Amount:
$ ___________
Drew University is hereby authorized to directly deposit my pay to the account listed above and to debit my
account in the event that an error results in overpayment. This authorization will remain in effect until I modify
or cancel it in writing. I understand that it may take up to two (2) payroll cycles for direct deposit to take effect.
Employee Signature
Date
JMH 5/2017

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