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REQUEST FOR DEPOSIT OF PAYROLL EARNINGS this form (University of the Incarnate Word)

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University of the Incarnate Word
St. Anthony Catholic HS & Incarnate Word HS
REQUEST FOR DEPOSIT OF PAYROLL EARNINGS
Return to: Payroll Office
Admin Bldg, Office 186
Employee Name: _______________________________________________________________
SSN or University ID: ___________________________________________________________
To enroll in direct deposit, complete this form and send to the Payroll Office. Attach a voided check for each
account – not a deposit slip. Below is a sample check detailing where the information necessary to complete
this form is found.
Please provide the following information of the financial Institution(s) to which your earnings will be deposited. For
multiple deposits, you must designate a percentage (%) or dollar ($) amount to be deposited.
Your Financial Institution: __________________________________________% or Dollar Amt:________
Routing Number: _____________________________Account Number: ____________________________
Your Financial Institution: __________________________________________% or Dollar Amt_________
Routing Number: _____________________________Account Number: __________________________
Check
ing
Savings
I hereby authorize UIW to deposit my payroll earnings to the financial institution(s) above and if
necessary to make adjusting entries if an incorrect deposit should be made into my account.
I understand that notification of payment will be provided through the MyWord Portal for Employees.
I understand that this authorization will continue in force unless discontinued by my written request and it is also my
responsibility to maintain the designated account(s) as open to prevent rejected or returned entries.
___________________________________________________________________________________
Signature Date
Student/Workstudy
Faculty
Staff
Administrator
Checking
Savings
New
Update
Cancel
Payroll 03/15/16
Your Financial Institution: __________________________________________% or Dollar Amt_________
Routing Number: _____________________________Account Number: __________________________
Checking
Savings
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REQUEST FOR DEPOSIT OF PAYROLL EARNINGS this form (University of the Incarnate Word)

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Completed 24 July 2020

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