Direct
Deposit
Authorization
Agr
eement
A Diverse Learning Community | An Equal Access/Equal Opportunity College
PLEASE
PRINT
Employee
Name (Printed)
Employee
ID
Phone
Number
I would like to:
START
a new direct deposit (you may
have
up to three accounts (refer
to
Note 1)
CHANGE
an
existing
direct deposit (refer
to
Note 2)
CANCEL
an
existing
direct deposit
PLEASE SELECT AT LEAST ONE FINANCIAL INSTITUTION BELOW:
Preferred Credit Union of Seminole State College
Account #
(check
one)
Checking
Account
Savings Account
Amount**
Account
Number
Bank Routing #
263181384
Financial
Institution
Name
Addition
FINANCIAL (
Preferred Credit Union of Seminole State College)
Account #
(check
one)
Checking
Account
Savings Account
Amount**
Account
Number
Bank Routing #
Financial
Institution
Name
Account #
(check
one)
Checking
Account
Savings Account
Amount**
Account
Number
Bank Routing #
Financial
Institution
Name
**Enter “Net Pay”, in the amount field, if you want the
balance
of your check deposited into this account.
Enter
the “Dollar Amount”, in
the amount field, if you want a portion of your pay to be deposited into another account. It is required to have one account designated
as
“Net Pay”.
I
hereby authorize and request
Seminole State
College
(Tax
ID Number: 59-1210158) to initiate credit entries, if
necessary,
debit entries
and
adjustments
for any credit entries in error, to my account at the financial institution named above.
This
authorization is to remain in
effect until withdrawn by me in writing with sufficient notice to
Seminole State
College to allow adequate time to effect termination of
the direct deposit.
This includes
my agreement to pay bank
services fees
for a rejected direct deposit to my
accoun
t which
results
from my
failure to notify
Seminole State
College, in a timely manner, that the account indicated above has been
clo
sed.
Employee Signature _______________________________________ _________________
Date
Note 1:
For
a new direct deposit, it may take up to two pay periods for the direct deposit to
process
to your account. A check may be
issued
for the first pay period and
possibly
the
second
pay period.
Note 2: When you make a change to your account number or your Bank Routing #, your net pay may be a check on the pay period
following the change. The
second
net pay you
receive
after making the change will be direct deposited.
Return
completed
form
to:
Payroll
Services: A-103
100 Weldon
Boulevard
Sanford, Florida
32773
Attach your
VOID check
if available
