Direct Deposit Form - Fordham University

FORDHAM

New York City’s Jesuit University

Direct Deposit Form

Send Completed form to Payroll Department, FMH, Room 519B: Please check one of the boxes below: Change Bank Stop Direct Deposit

Start Direct Deposit

Change A/C#

Checking Account Information Bank Name: ______________________________ Routing Number: ____________________________ Account #: ________________________________Percentage to be Deposited: ___________________%

Savings Account Information Bank Name: ___________________________Routing Number: ______________________________ Account #: _____________________________ Percentage to be Deposited: _____________________% Instructions: Please staple a Voided Check from your Checking Account and/or Transcript from your Bank with your Savings Account information. The Transcript will provide necessary information to setup your Savings Account. Your Savings Account cannot be setup without this information.

Attach Voided Check or Saving’s Deposit Slip Information EXAMPLE: (Digits found on the bottom left hand side of check) 021000000 0123456789 0123 ABA# (9 digits) Checking A/C # Check # I hereby authorize Fordham University to automatically deposit my net pay to my account(s) as indicated above on each regular payday. If funds, to which I am not entitled to, are deposited, I authorize my bank to honor my employer’s instructions to refund any amount it has deposited into my account. This authorization will remain in effect until I have cancelled it in writing. I understand that this request will take approximately two pay periods from the date of receipt by the Fordham University Payroll Department. Upon termination of employment with the University, the University will cease all direct deposits and future payments will be in the form of a live check. Employee Name:_____________________________________ Social Security #:____________________________ Employee Signature:__________________________________ Date:___________ Phone #___________________

To Be Completed by the Payroll Department Only:

Verified by:_________________________ Payroll Signature

__________________ Date

IC