SAMFORD UNIVERSITY
Human Resources Department
Authorization Agreement For Direct Deposit
Handout # - HR 103
THIS REQUEST REVISES ALL PREVIOUS DIRECT DEPOSITS
I (We) 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 (our) 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 required method of payment and that the payroll statement will be electronically sent to my
Samford University email address. 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 Payroll if your response changes in the future.
ATTACH VOIDED CHECK (NOT DEPOSIT SLIP)
Bank Name
Routing Number Account Number
Amount To Be Deposited in Checking Account
OR
Savings Account
***
Bank Name
Routing Number Account Number
Amount To Be Deposited in Checking Account
OR
Savings Account
***
Bank Name
Routing Number Account Number
Amount To Be Deposited in Checking Account
OR
Savings Account
This authority is to remain in full force until Company has received written notification from me (or either of us) 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 personal checks drawn on your bank account, verify with your financial institution that deposit was made.
Revised: 12/10
