Fillable AUTHORIZATION AGREEMENT FOR DIRECT DEPOSITS AS35 Louisiana State (Louisiana State University)

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AUTHORIZATION AGREEMENT FOR DIRECT DEPOSITS AS35 Louisiana State (Louisiana State University)

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______________________________________________________________ _______________________
-------------------------------------------------------------------------------------------------------------------------------------------------------------------
Louisiana State University
Office of Accounting Services
Payroll
204 Thomas Boyd Hall
AUTHORIZATION AGREEMENT FOR DIRECT DEPOSITS AS35
Employee ___________________________ __________________________________ ________
Last First MI
Action New Change LSUID ________________________________________
89-XXX-XXXX
I hereby authorize Louisiana State University (LSU) to initiate credit entries or reversing entries and to make adjustments for any
credit entries in error to my account at the indicated financial institution(s), and I hereby authorize the indicated financial institution
to accept and to post such entries to my account. I understand that it is my responsibility to verify the crediting of funds by my
financial institution prior to initiating disbursements against my account. This authorization may be terminated by LSU at any time.
Employees have the choice to deposit earnings in up to four bank accounts. If only one bank account is set up, Bank Account 1
designates the account to receive any balance funds left over after all other direct deposit instructions are processed.
You are responsible for ensuring the routing and account numbers on this form are correct. Contact your bank to confirm
routing/account numbers if you are unsure. Incorrect or illegible routing and/or account numbers will result in your pay being
delayed.
Bank Name- Acct 1
Bank Transit # Account #
Account Type Checking Savings
Balance
Bank Name- Acct 2
Bank Transit # Account #
Account Type
Checking Savings
Amount
Bank Name- Acct 3
Bank Transit # Account #
Account Type
Checking Savings
Amount
Bank Name- Acct 4
Bank Transit # Account #
Account Type
Checking Savings
Amount
Signature Date
*Please submit form to the LSU Payroll office at 204 Thomas Boyd Hall.
FOR ACCOUNTING SERVICES USE ONLY
Processed by _____________________________________________ Date __________________________
Rev 9/19
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AUTHORIZATION AGREEMENT FOR DIRECT DEPOSITS AS35 Louisiana State (Louisiana State University)

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Completed 22 August 2020

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