Bank Transit Routing Number Bank Account Number
Checking Savings Full Deposit Partial Deposit (amount per pay date)
Please return to the appropriate Department:
Graduate Students - Payroll Department
Undergraduate Students - Financial Aid Department
Administrators, Staff, Faculty - Human Resources Department
* I authorize Clark University and the bank(s) above to deposit my net pay or portion thereof as
indicated into my account each pay date.
* If funds to which I am not entitled are deposited to my account, I authorize Clark University to direct
the bank(s) to return said funds to Clark University.
* I understand that my deposit may not be credited to my account until 5:00 PM (EST) on the pay date
indicated on the check voucher.
Employee/Student Name (please print)
Banner ID number - if not known last 4
digits of SSN REQUIRED
Date Contact Number
Attach voided check or a letter from the bank stating routing and account number for each bank.