Direct Deposit Authorization Agreement
COMPANY
NAME: Metropolitan State University of Denver COMPANY ID: 84-0559160
I hereby authorize MSU Denver, hereinafter called COMPANY, to initiate credit entries and to
initiate, if necessary, debit entries and adjustments for any credit entries in error to my
Checking Savings account (select one) indicated below at the depository named below,
hereinafter called DEPOSITORY, to credit and/or debit the same to such account.
BANK DEPOSITORY
NAME:
ROUTING
NUMBER:
ACCOUNT
NUMBER:
This authorization is to remain in full force and effect until COMPANY has received written
notification from me of its termination in such time and such manner as to afford COMPANY
and DEPOSITORY a reasonable opportunity to act on it.
NAME: 900#:
(PLEASE PRINT)
Work Telephone
Number:
Home/Cell Phone
Number:
DATE: SIGNED:
NOTE: ALL WRITTEN CREDIT AUTHORIZATIONS SHOULD PROVIDE THAT THE RECEIVER
MAY REVOKE THE AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR IN THE
MANNER SPECIFIED IN THE AUTHORIZATION.
Employee Type:
Full-Time: Faculty,
Administrators, Classified Staff
Part-time Faculty Admin/Classified Hourly
PLEASE ATTACH VOIDED CHECK
OR
BANKING INSTITUTION
LETTER
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signature
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