Return to the Office of Employee Engagement (DS 126) for processing
Payment Option Enrollment Form
(Please SELECT ONE and complete either Direct Deposit, Mailed to, or Pick up Paycheck section and sign)
Direct Deposit Authorization (can select more than one deposit)
I authorize Daemen College to deposit my net paycheck into the account listed below. Direct Deposit will begin the payroll
period after receipt. Direct Deposit will remain in effect until we receive a written authorization for cancellation or change. If
you only have one bank account that you will be direct depositing, select Full Net Pay under account #1 box and leave #2
blank.
Deposit Account #1:
Bank Name: _____________________________________________________
Bank Routing Number: ____________________________________________
Account Number: _________________________________________________
Is this a CHECKINGS or SAVINGS account? (please mark one)
Deposit Account #2:
Bank Name: _____________________________________________________
Bank Routing Number: ____________________________________________
Account Number: _________________________________________________
Is this a CHECKINGS or SAVINGS account? (please mark one)
*Please attach a voided check for a checking account or deposit slip for a savings account to this form. A form from
your bank stating the account number, routing number, and your full name will also be accepted as long as it is NOT
handwritten. *Students: Initial Direct Deposit setup requires a pre-note. For STUDENT employees, your first paycheck
will be live meaning a paper check will be created to be picked-up in DS126 or mailed to your permanent address IF
you do not provide valid banking verification with this form (voided check, savings deposit slip, etc).
Have all paychecks mailed to my permanent address:
o Full Mailing Address: _____________________________________________
Pick up my paycheck on the stated pay dates: (reference payroll schedules located online)
o Employees are paid biweekly on Fridays and can pick up their paychecks in the Business Affairs Office
(DS 106) weekdays between 8:30am-4:30pm (Held in safe).
o Student Employees are paid biweekly on Wednesdays and can pick up their paychecks from The Office
of Employee Engagement (DS126) by showing a valid photo ID at the front desk.
________________________________________________
Print Name Legibly
____________________________________________________ ___________________
Signature Date
* Please note that every effort will be made to have your direct deposit available immediately, however you should always ensure that
there are appropriate funds in your account before making any withdrawals.
Account #1:
Amount to be deposited into
account:
Full Net Pay
Dollar Amount $______
Account #2:
Amount to be deposited into
account:
Full Net Pay
Dollar Amount $______
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome