ELECTRONIC FUNDS TRANSFER
For Accounts Payable Reimbursements
Name
Date
New
Change Cancel
lation
Bank Info
rmation
Bank Name
Checking Only
Transit ABA #
Account #
I hereby authorize Law Scho
ol Admission
Council to initiate the deposit in the above account for any
reimbursements due to me. This authority is to remain in full force and effect until LSAC has received
written notification from me of its termination in such time and in such manner as to afford LSAC and
depository a reasonable opportunity to act on it.
Signature
Date
Please return this form to Accounts Payable.