Butler University Payroll
Direct Deposit Authorization Form
Name (Please Print or Type)
Employee ID Last 4 digits of SSN number
Any new or changed direct deposit account information will take up to two pay periods to
begin and a check for your full pay will be issued in the interim.
Note: Up to two direct deposit accounts may be used. These accounts may be at different
banks. The first account must receive the balance of your paycheck. The second account is
optional and can be either a percent or a specific dollar amount of your paycheck.
To validate your information, a voided check or direct deposit sign-up form (available from
your financial institution) must be attached to this form. If you would like payroll to process
your direct deposit without this information, please check this box.
Account #1
Name of Financial Institution
City State Zip
Bank Routing Number (ABA) Checking or Savings
Account No. Net Pay x
Account #2
Name of Financial Institution
City State Zip
Bank Routing Number (ABA) Checking or Savings
Account No. % or Amount
Please note if you currently or in the future plan to forward your ACH payment (BU Payroll Direct
Deposit) to a non-U.S. bank, you cannot participate in Butler University’s direct deposit program.
I hereby authorize Butler University and the financial institution(s) entered above to deposit any
amounts owed to me to the account(s) entered above. In the event that Butler University deposits
funds in error, I authorize a debit from the account not to exceed the original amount that was in error.
This authorization will remain in effect until I have deleted the account information from the self-service
page or completed a Direct Deposit Authorization Form.
Signature Date
**Please note as of August 2016 employees can deposit their paycheck into as many as four accounts.
Attached is a second page for Account #3 and Account #4 information. Similar to Account #2, they are
optional and can be either a percent or a specific dollar amount of your paycheck. Page 1 of 2
START depositing into
bank account(s) listed below
STOP depositing into
bank account(s) listed below
CHANGE bank(s) and
account number(s) listed below
click to sign
signature
click to edit
![]()
