Revised July 2019
University of West Florida
Vendor Direct Deposit Authorization Agreement
Upon completing this form, submit to University of West Florida, Controller’s Office, Bldg 20E, 11000 University Pkwy.,
Pensacola, FL 32514, or email completed form to accountspayable@uwf.edu. If you have questions please contact 850-
474-3025.
Direct Deposit Action (Please Check One Option)
New Agreement Change to Current Agreement Cancel Direct Deposit
Vendor Information
UWF ID Number (If Known)
Vendor Name:
Street Address:
City, State, Zip:
E-Mail for Remittance Advice:
Vendor Contact Information
Name:
Email Address:
Phone Number:
Financial Institution Information
Account Type Checking Savings
Name of Financial Institution:
Phone Number:
Bank Routing Number(9 digits):
Account Number:
V
endor Agreement: I, the undersigned, hereby authorize and request the University of West Florida to initiate
credit entries, and, if necessary, a debit entry in accordance with NACHA rules reversing a credit entry made
in error, to my account at the above-named financial institution. This direct deposit is to remain in effect until
changed by: (a) an officer of the vendor; (b) the vendor’s legal representative; (c) the above-named financial
institution; or (d) the University of West Florida. Any change must be in writing and must be transmitted in a
timely manner for any change to take effect. A Direct Deposit Remittance Advice will be emailed to your E-Mail
for Remittance Advice address when a deposit occurs. If no email address is provided, remittance information
will not be sent. The University will not be responsible for any loss that may arise solely by reason of error,
mistake, or fraud regarding information provided on this form.
N
ote: Please make sure you notify us prior to closing your account. If a change to your bank account occurs
without the University receiving prior written notification, a delay in the receipt of funds will occur (up to 10
business days).
S
ignature of Company Official Date
Printed Name Title
V
erified by Accounts Payable
