Employee Direct Deposit Enrollment Form
To enroll in Full Service Direct Deposit, simply fill out this form and bring to Human Resources. Attach a voided check for
each checking account- not a deposit slip. If depositing into a savings account, ask your bank to give you the Routing/Transit
Number for your account. It isn’t always the same as the number on a deposit slip. This will help ensure you are paid correctly.
Important! Please read and sign before completing and submitting.
I hereby authorize Jacksonville University (hereinafter “JU”) to deposit any amounts owed me, as instructed by my employer, by
initiating credit entries to my account at the financial institution (hereinafter “Bank”) indicated on this form. Further, I authorize
Bank to accept and to credit any credit entries indicated by JU to my account. In the event that JU deposits funds erroneously
into my account, I authorize JU to debit my account not to exceed the original amount of the erroneous credit. This authorization
is to remain in full force and effect until JU and Bank have received written notice from me of its termination in such time and in
such manner as to afford JU and Bank reasonable opportunity to act on it.
Employee Name: __________________________________________ Social Security #: __ __ __ - __ __ - __ __ __ __
Employee Signature: ________________ _ ______________________ Date: ______
______________________________
Account Information
The last item must be for the remaining amount owed to you. To distribute to more accounts, please complete another form.
Make sure to indicate what kind of account, along with amount to be deposited, if less than your total net paycheck.
1.
Bank Name/City/State:
Routing/Transit #: __ __ __ __ __ __ __ __ __ Account Number: ___________________________________________
_ Checking _ Savings _ Other I wish to deposit: $ ________ . ____ or _ Entire Net Amount
2. Bank Name/City/State:
Routing/Transit #: __ __ __ __ __ __ __ __ __ Account Number: __________________________________________
_ Checking _ Savings _ Other I wish to deposit: $ ________ . ____ or _ Entire Net Amount
3. Bank Name/City/State:
Routing/Transit #: __ __ __ __ __ __ __ __ __ Account Number: __________________________________________
_ Checking _ Savings _ Other I wish to deposit: $ ________ . ____ or _ Entire Net Amount
ATTENTION - OFFICE OF HUMAN RESOURCES
Employers must keep each original employee enrollment form on file as long as the employee is using FSDD, and for
two years thereafter.
click to sign
signature
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