Fillable Employee Direct Deposit Authorization (California Institute of Technology)

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Employee Direct Deposit Authorization (California Institute of Technology)

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The Employee Direct Deposit Authorization (California Institute of Technology) form is 1 page long and contains:

  • 1 signature
  • 8 check-boxes
  • 14 other fields

Country of origin: US
File type: PDF

U.S.A. forms for California Institute of Technology

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Employee
This form is used to enroll, cancel or update how you receive payments from Caltech, that are not Payroll related. This form pertains only to
Retirees, Employees & Students of Caltech or JPL. Attach copy of a voided check to this form for the bank account you wish to deposit to. The
additional CEFCU direct deposit form attached only needs to be completed if you have a savings account with Caltech Employees Federal Credit
Union. Please allow 3 to 5 business days to complete your request.
Upload completed form at https://pdropbox.caltech.edu
or fax to: (626) 666-3928 with attention to Supplier Management
Payment Services Department
1200 E. California Blvd, MC 103-6
Pasadena, CA 91125
Hotline: 626-395-8900
Direct Deposit Authorization
Section 2 – Payee Information:
Instructions:
Section 4 - Authorization
Name (Last, First, Middle):
Full Address (associated with bank account):
Email address:
I authorize the California Institute of Technology to deposit payments into the bank account as indicated on this form. It is my responsibility to notify
Payment Services of any changes to the bank account entered above in a timely manner.
I authorize the California Institute of Technology to initiate credit entries and initiate, if necessary, debit entries and adjustments for any credit entries in
error to my account.
Name of Financial Institution:
Print Name:
Signature (required): Date:
Section 1 – Action Requested:
Enroll Cancel Update Information (fill out section 2 + only items to be changed)
Section 3 – Banking Information:
Branch Name (refer to front of check):
Account Name (name[s] of account owners): Account Number:
Bank’s ABA Routing Number:
For Internal Use Only:
SUPPLIER #________________
Note: Please attach a VOIDED CHECK to this form for the bank account you wish to deposit to
Retired from:
Telephone Number:
*If you have a savings account with CEFCU, please also fill out attached Direct Deposit Agreement form
Please check one:
Staff Faculty Grad Student Undergrad Student Academic Non-Faculty
UID #:
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signature
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Caltech Employees Federal Credit Union
Direct Deposit Agreement Form
Authorization Agreement
I hereby authorize Caltech EFCU to initiate automatic deposits to my account at the financial institution named
below. I also authorize Caltech EFCU to make withdrawals from this account in the event that a credit entry is
made in error.
Further, I agree not to hold Caltech EFCU responsible for any delay or loss of funds due to incorrect or
incomplete information supplied by me or by my financial institution or due to an error on the part of my financial
institution in depositing funds to my account.
This agreement will remain in effect until Caltech EFCU receives a written notice of cancellation from me or my
financial institution, or until I submit a new direct deposit form to the Payroll Department.
Account Information
Name of Financial Institution:
Caltech Employees Federal Credit Union
Routing Number:
3222-8069-2
Account Number:
Savings
Signature
Authorized Signature (Primary):
Date:
Authorized Signature (Joint):
Date:
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Employee Direct Deposit Authorization (California Institute of Technology)

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Completed 19 March 2021

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