Direct Deposit Authorization Form
Authorization Agreement for Direct Deposit Refunds
By signing this form, I agree to the following terms
and authorize my refunds to be deposited directly to my
checking account at the financial institution shown below:
I confirm that this bank account belongs to me. Joint accounts ar
e accepted as long as your name appears on the check or bank
that this bank account is a checking account.
This request will remain in effect until I have made a written request to stop or change my Direct Deposit.
It is my responsibility to notify the Student Accounts Office of any changes or closed accounts at least 6 business days prior to
my next refund.
I authorize George Mason University to initiate any credit and debit adjustments to my student account for refunds processed in
Will any portion of this refund be transferred to a foreign financial instituiton? Yes
Student Signature Date
Please visit the following link for instructions on how to upload the Direct Deposit Form securely to the Mason Student
Services Center.
Student Accounts Office
4400 University Drive, MS 2E2, Fairfax, Virginia 22030
Phone: 703-993-2484
By signing this form, I confirm that the information that I provided is accurate. I understand that
providing incorrect direct deposit information will delay my refund by up to 60 days.
Bank Name:
Bank Transit Routing Number (ABA):
(Note -this must be 9 digits)
Bank Account Number:
Name on Account:
Banking Information
Information must be clear and legible. If not, the form will not be processed and a refund check will be sent.
Student ID: G
- -
Student Name: _____________________________________________________________
Daytime Telephone Number: __________________________________________________________________________
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