Direct Deposit Authorization Form Travel and other Reimbursements
Note: Only one bank account can be set up for employee reimbursements.
This form is to be completed to authorize issuance of direct deposit reimbursement payments into 1) a bank
account other than the account on file for payroll transactions; or 2) to designate a reimbursement account when
there are multiple accounts used for payroll transactions. Any modification to payroll account information must
be made by contacting SOWELA’s Office of Human Resources. If you have only one account set up for payroll
deposits and that is the same account you wish to use for your employee reimbursements, you do not need
to complete and submit this form.
Please print and complete ALL the information below.
Name: ____________________________________________________________
Address: ____________________________________________________________
City, State, Zip: ____________________________________________________________
Name of Bank: ____________________________________________________________
Account #: ____________________________________________________________
9-Digit Routing #: ____________________________________________________________
Type of Account: Checking Savings (select one)
New account Account already on file (select one)
If a new account, please attach a voided check for the bank account to which funds should be deposited.
SOWELA Technical Community College is hereby authorized to directly deposit travel and other
reimbursements to the account listed above. The above does not affect information on file with the Office of
Human Resources for payroll purposes. This authorization will remain in effect, and on file in the Business
Office, until I modify or cancel it in writing.
Employee Signature: ______________________________________
Date: ____________________
click to sign
click to edit