FS Form Direct Deposit_022511
Direct Deposit Authorization
Financial Services Department
Payroll Office – Box 2458
Part I: Employee Information:
Employee Name: ___________________________________ Employee ID #: ___________________
_____ Faculty/Administrator _____Support Staff/Casual Employee _____Gettysburg College Student
Part II: Bank Information:
Action to be Taken:
_____ Start Direct Deposit _____ Change Existing Direct Deposit _____ Stop Direct Deposit
(Please list ALL accounts)
Bank Name
Routing #
Checking (C)
Deposit
|: __ __ __ __ __ __ __ __ __ |:
|: __ __ __ __ __ __ __ __ __ |:
|: __ __ __ __ __ __ __ __ __ |:
|: __ __ __ __ __ __ __ __ __ |:
If you are depositing into a checking account, please provide a voided check. If you are depositing into a
savings account, please provide documentation from your financial institution that includes the routing/transit
number and account number. Please allow at least one pay period for direct deposit to go into effect. You
may pick up your check in the Payroll Office until the direct deposit is effective.
Part III Authorization:
I authorize Gettysburg College and the financial institution(s) listed above to take selected actions, including the
initiation or termination of recurring correcting entries to the accounts(s) listed above. This authority is to
remain in effect until Gettysburg College has received written notification from me of its termination in such
time and manner as to afford Gettysburg College a reasonable opportunity to act on it; generally within 5 to 7
days of receipt.
Employee Signature: ___________________________________ Date: _________________________
For Financial Services Use Only:
Processed By: Date:
