Employee Direct Deposit Authorization
Domestic Payments Only – No International Direct Deposit
Type of Transaction (check one):
New
Change
Cancel
N
Last Name First Name
Middle Name
NSU ID #
Phone number E-Mail Address Department Location
Employee reimbursements (AP)
will be made to this account if no
o
ther account is specified below.
Only one account can be selected
for these payments. NOTE: If
employee is a student, any
student account refunds will also
be made to this account.
ACCOUNT # 2
SELECT TYPE: Checking Savings
Use this account for employee
reimbursements (AP) and
student account refunds.
Yes
No
Amount: $ __________
Yes No
Please sign, date and return this form providing the account number and the routing/transit number to the Payroll Department,
via interoffice mail (mail code: PAY), email (payroll@nova.edu) or fax to (954) 262-3997. By signing below, I am authorizing NSU
to initiate electronic credit entries and, if necessary, debit entries and adjustments for any credit entries made in error to my
account(s). This authorization remains in effect until NSU receives a written revised notification from me. It is my responsibility to
verify funds are available at my bank before making any transactions.
Additionally, by signing this form, I am confirming that the direct deposit is being made to a domestic financial institution and will
not be part of a back-to-back transaction to a foreign institution.
Signature: _________________________________________________________ Date: _______________________
Use this account for
employee
reimbursements (AP)
and
student
account
refunds
.
Name of Financial Institution: __________________________________________
Routing Number:
__________________
Acct #:
____________________________
ACCOUNT # 3
Savings
Amount: $ __________
Name of Financial Institution: __________________________________________
Routing Number:
__________________
Acct #:
____________________________
B
O
X
1
B
O
X
2
B
O
X
3
Name of Financial Institution: __________________________________________
Routing Number:
__________________
Acct #:
___________________________
SELECT TYPE:
Checking
Savings
PRIMARY ACCOUNT
SELECT TYPE: Checking
Revised 04/13/2016
Direct deposit is available for all employees and will be applied to employee reimbursements (including student employees),
student refunds issued by Accounts Payable (AP) and
for paychecks (issued by Payroll). Only one form is required to be
completed. You must indicate below how you want each type of check deposited.
Employee Reimbursements (AP): Depos
its can only be made to ONE CHECKING account. Select the box below indicating the
account the entire payment should be deposited to. If no selection is made, funds will be deposited into the PRIMARY ACCOUNT.
NOTE: If the employee is also a student, in addition to expense reimbursement, all student account refunds will be issued via
ACH to this checking account.
Payroll: Direct Deposit of your payroll check can be made into three (3) accounts. The first paycheck you receive after your form
has been received and processed will be a live paycheck. Once your account(s) have been verified by the financial institution you
provided, your subsequent pays will be directly deposited.
•
For one
account
only, complete only Box 1 (PRIMARY ACCOUNT) if you want 100% of your pay to go to this account.
•
For two(2) or more accounts, complete Box 2 and/or Box 3 for each account into which you want to deposit a specific amount.
Use even dollar amounts only. Complete Box 1 for the account into which you
would like the balance of your check deposited.
Changing or closing an account: It is IMPERATIVE that you notify Payroll prior to closing an account or if you have been
notified
of any changes in account number and the routing/transit number. Note: If you change, add, or close an account, you
must submit a new form reflecting this change. Failure to notify Payroll could cause a delay in payment.
BANKING information:
Attach a voided check to this form or contact your financial institution to provide you with printed
documentation of your account number and the routing/transit number to be used for ACH/Direct Deposit purposes.
click to sign
signature
click to edit
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