Fillable Central Connecticut State University - Direct Deposit and ACH Payment Enrollment Form

Fill Online, Printable, Fillable, Blank Central Connecticut State University - Direct Deposit and ACH Payment Enrollment Form Form

Use Fill to complete blank online CENTRAL CONNECTICUT STATE UNIVERSITY pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Central Connecticut State University - Direct Deposit and ACH Payment Enrollment Form

On average this form takes 8 minutes to complete

The Central Connecticut State University - Direct Deposit and ACH Payment Enrollment Form form is 1 page long and contains:

  • 0 signatures
  • 8 check-boxes
  • 28 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Central Connecticut State University

BROWSE CENTRAL CONNECTICUT STATE UNIVERSITY FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Type of Action (Please Check One)
Ne
w
Change Cancel
Individual Company
I am currently a State employee FEIN# ______________________________________
SSN# or Banner I. D. __________________________ (Federal Employee Identification Number)
Name: ____________________________________
O
rgan
i
za
ti
on: _______________________________
_
Address: ___________________________________
_
A
ddress: ___________________________________
_
Name: ______________________________________
Title: ______________________________________
_
Employee No. ______________________________
P
re
f
erre
d
N
o
tifi
ca
ti
on
i
s v
i
a e-ma
il
.
I have read, understand and agree to the Terms and Condition
s
on page 2.
Non-payroll: Purchasing at 860.832.2530 Payroll at 860.832.2520
Payroll ____________________________ Purchasing ________________________
Page 1
If you have any questions concerning ACH transactions, please contact:
Bank Name: ______________________________________________________________
FINANCIAL INSTITUTION INFORMATION
Signature: ________________________________________________________ Date: _______________
Bank Account Number: __________________________________________________
Nine-Digit Bank Routing Number:
(Primary) E Mail Address: _________________________________________________
(Secondary) Fax No.: __________________________________________________
Street
_________________________________________
For Business Office Use Onl
y
(
Initial and Date Recei
p
t of Form
)
City, State and Zip Code
Phone : ( ) ____________________________
NOTIFICATION METHOD - FOR NON-PAYROLL CHECKS
Payroll Office Use Only
Pay Period: ______________________________
Type of Account : Savings Checking
_________________________________________
City, State and Zip Code
Phone : ( ) ____________________________
Street
Submit original form to:
ACH/Direct Deposit Unit
Marcus White Annex 006.
Direct Deposit and ACH Payment
INDIVIDUAL/COMPANY INFORMATIO
N
Retain a copy of this agreement
for your records.
See Page 2 for Terms and Conditions.
Enrollment Form
Non Payroll ACH:
Payroll ACH:
12.20.05
Page 2
In the event my employment with the State is terminated for any reason whatsoever, and if at the time of such
termination I have had unearned pay automatically deposited in my checking/savings account, I will immediately repay
such unearned pay, I will be personally liable for all costs of collection, including reasonable attorney's fees incurred b
the State in the collection of such unearned pay, together with the maximum interest by law. I must notify the
Personnel Office three (3) weeks in advance of closing the above account. If I fail to do so, I understand that it may
take up to two (2) weeks to recover funds sent to a closed account.
TERMS AND CONDITIONS
In the event that the State notifies the bank that the funds, which I did not earn, have been deposited to my account in
error, I hereby authorize and direct the bank to return said funds to the State as soon as possible. In the event such
unearned funds have been drawn from that account so that return of those funds by the bank to the State is not
possible, I hereby authorize the State to recover those funds by deducting the amount of said unearned funds from any
future salary payments from the State until the amount of the unearned deposit has been recovered in full.
Submission of the Direct Deposit and ACH Payment Enrollment Form authorizes Central Connecticut State University to
electronically deposit payments through the Federal Automated Clearing House (ACH) to the bank listed on page one pertaining to
payroll checks, travel, refunds, refunds (including Title IV) and vendor (company or individual), whichever is applicable.
This authorization is to remain in full force and effect until vendor (company or individual) provides advance written
notice of termination or in such a time and manner to afford the State and the bank named on page one a reasonable
opportunity to act on it. It is the sole responsibility of the vendor (company or individual) to stop such transactions.
CCSU may reverse any duplicate or erroneous credit entry.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Central Connecticut State University - Direct Deposit and ACH Payment Enrollment Form

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 26 May 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document