Human Resources | 900 Dayton Street, Yellow Springs, OH 45387|937.769.1375 | www.antioch.edu
AU Direct Deposit Authorization-2019 revised.doc
AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITS (ACH CREDITS)
1. I hereby authorize ANTIOCH UNIVERSITY, herein called COMPANY, to initiate CREDIT entries and to initiate, if
necessary, DEBIT entries and adjustments for any CREDIT entries in error to my bank (depository) as indicated below:
(Please either fill out OR attach a voided check.)
A) DEPOSITORY BANK’S NAME
DEPOSITORY BANK’S ROUTING NUMBER
EMPLOYEE’S BANK ACCOUNT NUMBER Checking or Savings (circle one)
DEPOSIT AMOUNT ___ ____ __
B) DEPOSITORY BANK’S NAME
DEPOSITORY BANK’S ROUTING NUMBER
EMPLOYEE’S BANK ACCOUNT NUMBER Checking or Savings (circle one)
DEPOSIT AMOUNT _______ __ (remainder of pay if more than one account listed)
(You may complete more than one form if you want to deposit into more than two banks)
This authority is to remain in full force and effect until either (1.) COMPANY has received written notification from me of
its termination in such time and in such manner as to afford COMPANY and DEPOSITORY BANK a reasonable
opportunity to act on it; (2.) my employment with COMPANY has been completely terminated, or (3.) the direct-deposit
deactivation date that I specified below has passed.
4. EMPLOYEE NAME ______________ Employee AUID# or last four digits of SSN ______
(Used for identity verification)
EMPLOYEE’S AUTHORIZING
SIGNATURE DATE
RETURN COMPLETED FORM TO YOUR HUMAN RESOURCES OFFICE. THANK YOU!
Please attach a voided check and return this completed form to your Human Resources office at least 3 days before the end of
the pay period. Your direct deposit should begin within one pay period after we receive your completed form.
**NOTIFY PAYROLL IMMEDIATELY IF YOU CLOSE OR CHANGE BANK ACCOUNT**
**Payroll Direct Deposits can NOT be changed on AUView**
**Any changes to direct deposit account (new or closed account) must be submitted at least 3 days before the end of the pay period.
AU is not responsible for returned funds due to delay in providing AU an updated direct deposit form and written notification.
OPTIONAL: To request that Antioch University deactivates your direct deposit.
I hereby terminate my authorization for COMPANY to deposit my pay into my bank account(s) effective the first
payday AFTER the following date:_______________________________________________
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signature
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