COMPTROLLER'S OFFICE
ALABAMA A&M UNIVERSITY | Business Office
Request Type:
New
Name:
Banner ID:
Last four digits of SSN (for new employees):
Account #1 - Percent/Amt Account Type
Check here if you are only changing the percentage
Bank/Financial Institution:
Routing Number: Account Number:
Account #2 - Percent/Amt Account Type
Check here if you are only changing the percentage
Bank/Financial Institution:
Routing Number: Account Number:
Signature: Date:
Account Information
Please deposit the indicated percentage or amount of my check into one of the following and the remainder into the other account.
Direct Deposit Enrollment For
Authorization Agreement
I hereby authorize Alabama Agricultural and Mechanical University to direct deposit all my payments to my financial institution(s)
listed below until I terminate this agreement in writing. A terminated or new agreement shall become effective within the next two
pay periods following receipt of this form.
In the event that funds are erroneously deposited into my account(s), I authorize Alabama Agricultural and Mechanical University or
the depository institution to debit my account(s) for the purpose of correcting the error.
I acknowledge that:
(1) It is my responsibility to verify my account balance prior to making disbursements or withdrawals.
(2) Alabama A&M University assumes no liability for bank errors, bank fees, or overdrafts.
(3) Deposit rejections will not be reprocessed until funds have been redeposited into the University's account.
(4) A new authorization must be completed when changing accounts or financial institutions, or when closing an account.
(5) If I have not provided a voided check or direct deposit authorization form from my financial institution,
I take full responsibility for delays and/or charges to my account that may be the result of providing
incorrect information.
I certify that the information provided on this form is correct and that I am authorized to execute this document.
REQUIRED: To ensure the account information provided is valid, please attach a voided check or a direct deposit authorization form from your financial
institution with account, account type, and routing information. An email will be sent to the address provided below once the form has been processed. This
form must be completed permanent ink. SUBMIT TO Patton Hall room 105 or fax to 256-372-5192.
Change
Termination
Checking
Checking
Savings
Savings
Business Office Use Only
Completion Verification
Payroll:
A/P:
Phone:
Email:
*** Splitting direct deposits is only available for PAYROLL. If more than one account is listed below, all
non-payroll deposits will be made into the first account listed below. ***
Revised 11/09/2018
