Direct Deposit Authorization for Travel form, Rev. 3/18/2008
Authorization Agreement for Direct Deposit
Travel Reimbursements Only
The University of West Georgia can only deposit funds to an account that bears the employee’s name.
The employee’s name must be on the voided check that is attached to this form.
Your first payment after completing this form will be a paper check, and the next payment should be
directly deposited into your account(s).
Employee ID ________________________ Name __________________________________________
Email ______________________________
I hereby authorize the University of West Georgia to initiate credits of my travel reimbursement and/or
correction debits to previous credits via electronic transfer to my account at the following bank. I
understand it is my responsibility to insure that funds have been deposited; and, if not, will notify the
Office of the Controller immediately.
Unfortunately we can deposit Travel Reimbursements into a Checking Account only.
Attach Voided Check
_________________________ __________________________________________
Date Signature
