Fillable 1. Employee name 2. Social Security Number 3. (West Virginia Northern Community College)

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1. Employee name 2. Social Security Number 3. (West Virginia Northern Community College)

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U.S.A. forms for West Virginia Northern Community College

BROWSE WEST VIRGINIA NORTHERN COMMUNITY COLLEGE FORMS

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TRAVEL DIRECT DEPOSIT FORM INSTRUCTIONS
In order to process your direct deposit request the following information must be provided:
1. Employee name
2. Social Security Number
3. wvOASIS Vendor /Customer Number - Can be provided by your Accounts Payable Department.
For those agencies currently on the New Travel System please provide the wvOASIS Employee ID.
4. Provide an email address for payment notifications.
5. Home mailing address
6. Phone Number
Account Information
1. List the Bank name. Your payment will be going to the Bank name listed.
2. Indicate by marking the appropriate boxes.
a. Start Direct Deposit
Your payment is currently not setup for direct deposit.
b. Change Account Information From
Your direct deposit is currently setup and you want to send your funds to a different account or
Bank. You must list the current Bank Name, Routing and Account number on file. Do not
close your old account until you have received your payment in the new account. This
will help prevent a delay in receiving your payment.
c. Change Account Information To
You must list the new Bank Name, Routing and Account number.
3. Indicate whether the account is checking or savings. Mark one box ONLY!
a. Checking
Attach a voided check, Financial Institution statement, or a letter from the Financial
Institution (on FI letterhead) containing the account information, printed name, title and
signature of the Financial Institution representative.
b. Saving
Attach a Financial Institution statement or letter from the Financial Institution (on
F.I. letterhead) containing the account information, printed name, title and signature
of the Financial Institution representative.
TRAVEL DIRECT DEPOSIT FORM INSTRUCTIONS
Employee must do the following:
1. Complete, sign and date the form.
2. Deliver the form with your account documentation to your payroll or accounts payable
representative for completion.
Payroll or accounts payable representative must do the following:
1. Complete the State Agency field.
2. Review the form and make sure it has been completed.
3. Make sure the Business Designation Code (Employee Reimbursement) in wvOASIS is correct.
4. Sign and date the form confirming it was provided by the employee.
5. Forward the form along with the documentation to the Auditor's Office.
I hereby certify I am a payroll/accounts payable representative of the herein name State Agency and that being so authorized I do certify
the information listed and attached with this authorization has been received from the employee indicated above.
Pursuant to Section 7 of the Privacy Act of 1974, the disclosure of your Social Security Number is mandatory. Social Security Numbers are necessary to properly maintain records concerning your direct
deposit payments as is required and authorized by the federal government for tax administration purposes. See generally, 42 U.S.C. § 405(c). Failure to provide a Social Security Number will prevent us
from processing your direct deposit request.
Start Direct Deposit
Checking - Attach a voided check
Saving
Change Account Info To
Checking - Attach a voided check
Saving
Employee Signature: Date:
State Agency:
Phone #:
Payroll/AP Representative’s Signature:
Date:
Change Account Info From
OASIS
WV
Travel Direct Deposit Form
West Virginia State Auditor’s Office, ePayments DivisionTelephone:
1-800-500-4079 Fax: (304) 340-5084 www.wvsao.gov
Account Information:
PLEASE FORWARD TO YOUR STATE AGENCY PAYROLL/AP DEPARTMENT ONCE COMPLETED
FIRST NAME: MI: LAST NAME:
wvOASIS
Vendor Customer #:
SSN:
BANK NAME:
ROUTING #:
ACCOUNT #:
BANK NAME:
ROUTING #:
ACCOUNT #:
Phone #:
Address 1:
Address 1:
City:
State: Zip Code:
Email Address:
I hereby authorize the State of West Virginia, hereinafter called STATE, to initiate credit entries to the account(s) as indicated above and to
initiate debit entries as adjustments for credit entries made in error. The STATE will not be responsible for any loss that may arise solely
by reason of error, mistake or fraud regarding information provided on this form. This authority is to remain in full force and effect until I
have filed a new travel form in a timely manner so as to afford the STATE a reasonable opportunity to act.
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1. Employee name 2. Social Security Number 3. (West Virginia Northern Community College)

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Completed 9 October 2020

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