SAMFORD UNIVERSITY
Accounting and Financial Services
Authorization Agreement for Direct Deposit
THIS REQUEST REVISES ALL PREVIOUS SUBMISSIONS TO ACCOUNTING (NOT PAYROLL)
I hereby authorize Samford University, hereafter called "Company", to initiate credit entries and to
initiate, if necessary, debit entries and adjustment for any credit entries in error to my account
indicated below and the depository names below, hereinafter called "Bank", to credit and/or debit the
same to such account. I understand that direct deposit is Samford's preferred method of payment for
expense reimbursements. I acknowledge that direct deposits to the designated account(s) must
comply with the provisions of U.S. law, as well as the requirements of the Office of Foreign Assets
Control (OFAC).
Will this deposit be transferred to an account outside the United States? ___Yes ___No
Should I choose Yes, I understand that any electronic payments that may be remitted to
me may be labeled with "IAT" as the standard entry class. I acknowledge that availability
of funds credited to the account will be subject to my receiving financial institution's
policies and procedures.
Please notify Accounting if your response changes in the future.
ATTACH VOIDED CHECK (NOT DEPOSIT SLIP)
Bank Name ______________________________________________
Routing Number ______________________ Account Number ________________________________
____ Checking Account OR ____ Savings Account
This authority is to remain in full force until Company has received written notification
from me of its termination in such time and in such number as to afford Company and
Bank a reasonable opportunity to act on it.
Name: ____________________________ SUID: ______________________________
Signature: __________________________ Date: ______________________________
Before writing a personal check drawn on your bank account, verify with your financial institution that
deposit was made and funds are available for withdrawal.
