Revised 2/25/2020
DIRECT DEPOSIT AUTHORIZATION FORM
INCLUDE A VOIDED PERSONAL CHECK(S) WITH DDA FORM FOR CHECKING ACCOUNT VERIFICATION.
FOR SAVINGS ACCOUNT(S), PLEASE VERIFY ACCOUNT AND TRANSIT ROUTING NUMBER(S) WITH YOUR FINANCIAL INSTITUTION(S).
BANKING CO
DES ON DEPOSIT SLIPS ARE NOT ACCURATE FOR DIRECT DEPOSIT PURPOSES.
Employee ID
Last Name First Name M.I.
Pay will be forwarded to an international bank (required by IAT)
Yes
DIRECT DEPOSIT #1
If choosing one banking option, provide banking information and check the “Full Deposit” box. If choosing 2 or 3 additional banking options,
provide banking information and enter the partial amount.
Name of Financial Institution Account Type: □ Checking □ Savings
Bank phone number ___ Partial Amount $ ________ _ □ Full Deposit
Transit Routing Number ____________________________ Account Number ________________________________
DIRECT DEPOSIT #2
If choosing 2 banking options, provide banking information and check “Balance” box. If choosing 3 banking options, provide banking
information and enter the partial amount.
Name of Financial Institution Account Type: □ Checking □ Savings
Bank phone number ___ Partial Amount $ __________ □ Balance
Transit Routing Number ____________________________ Account Number ________________________________
If choosing 3 banking options, provide banking information and check “Balance” box.
Name of Financial Institution ___ Account Type: □ Checking □ Savings
Bank phone number ___ □ Balance
Transit Routing Number ____________________________ Account Number _______________________________
AGREEMENT
By signing below, I hereby authorize the University of Central Florida (UCF) to initiate credit entries and, if necessary, debit entries in accordance with
NACHA rules reversing credit entries made in error to my account(s) at the financial institution(s) named. This Direct Deposit Agreement is to remain
in effect until changed or withdrawn by: (a) me in writing with sufficient notice to UCF to allow adequate time to effect termination, (b) my death or legal
incapacity, (c) the financial institution(s), (d) UCF. I certify the banking information provided on this form has been verified by me prior to signing
below.
The University of Central Florida will not be responsible for any loss that may arise solely by reason of error, mistake, or fraud on
information provided on this Electronic Payment Authorization form.
Spec
ial Note: Please make sure Direct Deposit(s) are changed and in effect before closing your account(s). Otherwise, the funds will be returned to
UCF and cause a 7-10 day delay before a replacement payment can be issued.
Employee signature __________________________________________________ Date __________________________
THIS FORM MUST BE SIGNED AND DATED BY PAYEE.
Signature above signifies acceptance of the terms and conditions in the AGREEMENT.
