Boise State University
Direct Deposit Form
AUTHORIZATION*AGREEMENT FOR*AUTOMATIC*PAYROLL DEPOSITS
Employee Name: __________________________________________________________
Employee ID: _____________________________________________________________
Bank / Credit Union*Name: __________________________________________________
Routing Number: __________________________________________________________
Account Number: __________________________________________________________
Type of Account:* Checking _______ o Savings ________
I hereby authorize Boise State University to initiate credit entries, and to initiate, if necessary, debit
entries and adjustments for any credit entries in error to the account indicated above. I also authorize
the above named depository to credit and/or debit the same to my account. I understand Boise State
will make every effort to notify me before such action is taken.
This authority is to remain in full force and effect until Boise State University has received written
notification from me two weeks prior to the termination of the direct deposit or if I elect to make a
change on HR Self Service. If Boise State does not receive two weeks’ notice I understand that this may
cause a delay in the receipt of my paycheck.
As required by the Federal Office of Foreign Asset Control in support of U.S.C. Title 50, War and National
Defense, I attest that the full amount of my direct deposit is not being forwarded to a bank in another
country and that if at any point I establish a standing order for my receiving back to forward the full
direct deposit to a bank in another country, I will inform my employing institution immediately.
Signature: _______________________________________________________________
Date: ___________________________________________________________________*
Return for to: Payroll Services, 1910 University Drive MS1265, Boise ID 83725-1265. Located in Capitol
Village #3. Campus mail 1265. Fax: 208-426-3100
Rev 6/2018
