AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITS
(ACH CREDITS)
Employment Status: Full-Time Adjunct Student
Employee Name: Employee ID#
Department
:
Telephone:
I
HEARBY AUTHORIZE PENSACOLA STATE COLLEGE TO INITIATE CREDIT ENTRIES AND TO INITIATE, IF NECESSARY, DEBIT ENTRIES
AND ADJUSTMENTS FOR ANY CREDIT ENTRIES IN ERROR TO MY
:
Type of Request New Set-Up Change Cancellation
Account Type Checking Savings
Financial Institution Name
Financial Institution Phone Number
VOIDED CHECK OR DIRECT DEPOSIT ENROLLMENT FORM MUST BE ATTACHED (except for cancellations)
This authority is to remain in full force and effect until Pensacola State College has received written notification from me of
its termination in such time and in such manner as to afford Pensacola State College and the financial institution a
reasonable opportunity to act on it.
Note: In an effort to expedite the efficient processing of your direct deposit request, the direct deposit is set up
as a pre-
note. This allows Pensacola State College and the financial institution the opportunity to ensure that all
information is
transmitted accurately. Therefore a hard copy (paper) check is issued for the pay period following the initial direct deposit
set-up and must be picked up from the Cashier's Office. For changes to direct deposit - the payroll check is mailed to the
employee address on file.
(Please Initial)
I
acknowledge that my first pay-check will be a paper check that has to be picked up from
the Bursar’s
office on any of our three campuses. Please indicate which location you prefer.
First check
pick up location:
PENSACOLA MILTON
WARRINGTON
Signature: Date:
Human Resources Department
1000 College Blvd., Pensacola, FL 32504
Phone: (850) 484-1760 Fax: (850) 484-1711
Revised 09/2019
click to sign
signature
click to edit
![]()
