AUTHORIZATION AGREEMENT FOR DIRECT DEPOSIT (ACH CREDITS)
Updated November 9, 2011
Vendor Name:
Federal Tax ID #:
New Authorization Update existing authorization Cancel authorization
Accounts Payable Use Only
Account Name:
Email Address*:
Contact Name:
Phone Number:
Address:
City: State: Zip:
Bank Name:
City: State: Zip:
Account Number*:
Routing Number*:
Checking Savings
Type of Account
Signature _____________________________________________________
Printed Name __________________________________________________ Title __________________________________
Date __________________________________
I certify that the information I provided is correct and that I am an authorized signer or designate of the account provided for
direct deposit transactions and am entitled to provide this authorization. I (we) hereby authorize Golden Gate University to
initiate credit entries to the account and financial institution listed above. I (we) further authorize adjusting entries (reversals) to
correct errors, if any. This authorization is to remain in full force and effect until Golden Gate University has received written
notification from me (us) of its termination in such time and manner as to afford Golden Gate University and the depository
financial institution a reasonable opportunity to act on it. I (we) understand that if any of the account information above is
incorrect, GGU will issue a check and cancel this authorization. I (we) further understand that GGU will transmit a remittance
advice via email if a valid email address is entered above.
I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the
provisions of U.S. Law.
Oracle Vendor # Oracle Vendor Name
NACHA rules require that GGU obtain authorization from each vendor before transmitting ACH credits. Note: this form is not
to be used for wire transfers. Please complete all the information on this form and mail to: Accounts Payable Office, Attn: Tracy
Chang, 536 Mission St, San Francisco, CA 94105. Please do not email or fax this form.
*Contact your bank for help determining the appropriate routing and account numbers for ACH transactions. Do not provide wire transfer information.
*Please enter a valid email address to receive a remittance advice for payments.
