Fillable Direct Deposit (Alvin Community College)

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Direct Deposit (Alvin Community College)

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EMPLOYEE DIRECT DEPOSIT AUTHORIZATION
Direct Deposit is mandatory at Alvin Community College. If depositing to a savings account, request the Routing/Transit Number from the financial
institution; it is not always the same as the number shown on a savings deposit slip. Completed forms may be submitted to the Human Resources
Office or the Business Office. Optional: A copy of a voided check (not a deposit slip) for each checking account may be attached.
(PRINT OR TYPE)
EMPLOYEE INFORMATION
NAME:
SSN:
MAILING ADDRESS:
STREET OR PO BOX
CITY
STATE
E-MAIL ADDRESS:
(E-mail address is required for receipt confirmation)
HOME PHONE:
WORK PHONE:
CELL PHONE:
TRANSACTION REQUEST
NEW AUTHORIZATION
CHANGE FINANCIAL INSTITUTION / ACCOUNT
ADD NEW ACCOUNT INFORMATION
Below is a sample check MICR line, detailing where the information necessary to complete this form can be found.
Memo
I: 012345678 I:
123456789
0101
ACCOUNT INFORMATION (Make sure to indicate the type of account, along with the amount to be deposited fi less than your total net paycheck)
ACCOUNT # 1
FINANCIAL INSTITUTION:
ACCOUNT TYPE:
CHECKING
SAVINGS
CITY / STATE:
ROUTING/TRANSIT #:
PHONE:
ACCOUNT #:
AMOUNT TO DEPOSIT:
$
or
BALANCE OF NET
ACCOUNT # 2
FINANCIAL INSTITUTION:
ACCOUNT TYPE:
CHECKING
SAVINGS
CITY / STATE:
ROUTING/TRANSIT #:
PHONE:
ACCOUNT #:
AMOUNT TO DEPOSIT:
$
or
BALANCE OF NET
ACCOUNT # 3
FINANCIAL INSTITUTION:
ACCOUNT TYPE:
CHECKING
SAVINGS
CITY / STATE:
ROUTING/TRANSIT #:
PHONE:
ACCOUNT #:
AMOUNT TO DEPOSIT:
$
or
BALANCE OF NET
AUTHORIZATION / CERTIFICATION
I authorize Alvin Community College to deposit, via electronic transfer, all payroll payments owed to me by Alvin Community College to the account designated
below. I recognize that if I fail to provide complete and accurate information, the processing of the funds may be delayed.
I authorize Alvin Community College to withdraw from the designated account or deduct from my subsequent salary, if any, all amounts deposited in error. If the
designated account is closed or has an insufficient balance to allow the withdrawal, then I authorize Alvin Community College to withhold any payments owed to me
until the amounts are repaid.
I understand that if I have any changes in banking information, I must submit a new Direct Deposit Authorization form.
In consideration for Alvin Community College making direct deposit through agreement with the current Depository for College funds, the undersigned releases the
liability and waives all claims for direct, indirect, and consequential damages resulting from errors and omissions, if any, made by Alvin Community College, its
trustees, agents, or employees, or by the current Depository for College funds, as authorized by me. This release of liability does not release Alvin Community
College or the current Depository for College funds from any claim for damages resulting from failure of either Alvin Community College or the current Depository
for College funds to act in good faith.
I authorize direct deposit of my monthly salary as specified above.
AUTHORIZATION DATE:
(R 10/01/14)
ALVIN COMMUNITY COLLEGE ■ 3110 MUSTANG ROAD ■ ALVIN, TEXAS 77511
281.756.3500 ■ www.alvincollege.edu
Routing/Transit #
(A 9-digit number always
between these two marks)
Checking Account #
Check #
Corresponds to the number in the upper right corner
of the check; not required for direct deposit
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Direct Deposit (Alvin Community College)

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Completed 24 July 2020

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