Fillable Authorization Direct Deposit (Dickinson State University)

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Authorization Direct Deposit (Dickinson State University)

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The Authorization Direct Deposit (Dickinson State University) form is 1 page long and contains:

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  • 16 check-boxes
  • 26 other fields

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File type: PDF

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EMPLOYEE INFORMATION
AUTHORIZATION FOR DIRECT
DEPOSIT OF EMPLOYEE PAY
(Please print or type all information)
EMPLID#
HOME PHONE
LAST NAME
FIRST NAME
MI
WORK PHONE
ENROLLMENT OR CHANGE AUTHORIZATION
Complete this section for new enrollment, financial institution or account changes.
ACCOUNT: % OR $ OF NET DISTRIBUTION:
%
OR
$
SELECT ONE:
New Enrollment Change
ACCOUNT TYPE (CHECK ONE)
Checking
Savings
NAME OF BANK
*
ROUTING
#
*
ACCOUNT
#
Please attach a voided check blank for this account
ACCOUNT: % OR $ OF NET DISTRIBUTION:
%
OR
$
SELECT ONE:
New Enrollment Change
ACCOUNT TYPE (CHECK ONE)
Checking
Savings
NAME OF BANK
*
ROUTING #
* ACCOUNT #
Please attach a voided check blank for this account
ACCOUNT: % OR $ OF NET DISTRIBUTION:
%
OR
$
SELECT ONE:
New Enrollment Change
ACCOUNT TYPE (CHECK ONE)
Checking
Savings
NAME OF BANK
*
ROUTING #
* ACCOUNT #
Please attach a voided check blank for this account
ACCOUNT: % OR $ OF NET DISTRIBUTION:
%
OR
$
SELECT ONE: New Enrollment Change
ACCOUNT TYPE (CHECK ONE)
Checking
Savings
NAME OF BANK
*
ROUTING
#
*
ACCOUNT
#
Please attach a voided check blank for this account
I authorize the State of North Dakota, to initiate accounting transactions to deposit my employee pay and reimbursements directly to the
account(s) indicated above and to correct any errors which may occur from these transactions. I also authorize the Financial Institution to
post these transactions to these accounts. This authorization is to remain in force until the State of North Dakota receives written notice
from me to cancel or change this authorization. I understand that submission of this request will supersede any other direct deposit requests I
have submitted to the State of North Dakota. I understand that this agreement does not apply to student financial aid or other student
refunds. I understand I must file a separate Direct Deposit Authorization with the Office of Business Affairs to authorize direct deposit of
student financial aid or refunds.
Submit To: Office of Human Resources
Box 181, May Hall 101
EMPLOYEE SIGNATURE
DATE
Important Notice: Due to the time required for payroll and bank processing, allow one or two pay periods for implementation. YOU WILL
ALWAYS RECEIVE A CHECK until the changes can be processed. 12/13/13
Direct Deposit Information and
Instructions
On pay day, you may view your paystub information via HRMS Employee Self Service.
For non-payroll transactions, (such as travel reimbursements), you will receive a
remittance advice detailing the amount direct deposited. Contact the Business
Office if you prefer to receive a check for non-payroll transactions
.
The amount of the direct deposit for all types of payments will appear on your
bank statement.
Instructions for Completion of the Authorization for Direct Deposit:
1. EmplID: Enter EmplID, if known.
2. Enter Home Telephone Number, Last Name, First Name and Work Telephone
Number.
3. Complete Account Information.
a. Select whether this is a request for a NEW account or to CHANGE an
account.
b. Indicate whether it is a checking or savings account.
c. List the name of the bank.
d. Record the Routing and Account Numbers. These numbers can be
found on one of your checks. DO NOT use numbers from a deposit
slip – those numbers are not the same.
Use this example to identify the numbers on your check.
4. Attach a voided check to the form.
5. Complete the information for any additional accounts(s) and enter a specific
dollar amount or percentage of net pay . Attach a voided check
for each checking account.
6. Read the information at the bottom of the form, sign and date. Please note:
This request supersedes any previous requests at any other ND State Agency
or ND higher education institution and will cause all payroll payments for any
of those entities to be deposited according to this request.
7. Due to the time required for payroll and bank processing, allow one or two
pay periods for implementation. YOU WILL ALWAYS RECEIVE A CHECK until
the changes can be processed.
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Completed 27 July 2020

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