Employee Direct Deposit Electronic Funds Transfer (EFT)
Agreement
Instructions: Fill out this form, print and sign and either:
1. Scan and email as an attachment to TWUVendor@twu.edu
2. Fax to (940)
898
-3519
TRANSACTION TYPE
New Setup Change Financial Institution
Cancellation Change Account Number
Change Account Typ
e
PAYEE INFORMATION
Employee Identification # Employee Name Business Phone
Remit Address City State Zip Code
FINANCIAL INSTITUTION INFORMATION
Name City State
Chec
king Savings
Routing Transit Number Account Number Account Type
AUTHORIZATION
I hereby authorize Texas Womans University (TWU) and the depository named above to initiate direct deposit
(credit) entries and correction (debit) entries to the depository account listed above. This authorization will remain in
effect until Procurement and Contract Services receives written notification of cancellation.
Authorized
Signature Date
Printed
Name and Title
Remittance
Email Address
*************** PLEASE ATTACH A VOIDED CHECK (NOT A DEPOSIT SLIP) TO THIS FORM BELOW ***************
Procurem
ent and Contract Services
P.O. Box 425439 / Bralley Annex ● Denton, TX 76204-5439 ● P: (9640) 898-3528 F: (940) 898-3519 Rev
09/16
click to sign
signature
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