Form updated on January 28, 2020
Purchasing PO11
SUPPLIER DIRECT DEPOSIT FORM
Direct deposit services are currently only available for Canadian bank accounts
You must attach a void cheque or letter of guarantee from the bank. Cheques will be issued for all USD payments. If
you require a payment to be made in an international currency (other than USD), please contact Accounts Payable
for information on the Wire Payment Process. Payment to the supplier will not be issued until all required direct
deposit information is received by the University of Windsor.
Application Type: New Application Change of Information Cancel Direct Deposit
University of Windsor Departmental Contact
Date (YYYY-MM-DD): Contact Name:
Contact Department: Email: Extension:
Supplier Information
The Supplier Name and Address provided below must agree exactly to the Supplier Name and Address on the void
cheque or Letter of Guarantee from the bank.
Company or Individual Name:
Contact Name:
Telephone: Email for Payment Notice:
Address:
City: Province/State:
Country: Postal Code/Zip Code:
Signature: Date:
Collection of Personal Information
The information collected for the Supplier Direct Deposit form is collected under the authority of the University of
Windsor Act and is collected for the purpose of providing direct deposit of funds for payment of invoices.
Information provided to the Finance Department for supplier direct deposit will be used only for that purpose and
will be accessed only by persons so authorized.
Authorization
I authorize the University of Windsor to credit the bank account indicated on the attached document. I will notify
Procurement in writing if I change the account from one bank or branch to another, or if there is any other change.
I have retained a signed copy of this authorization form. For your approval of the form and to confirm all
information is accurate please sign form below (hand written or digital signature is required).
click to sign
signature
click to edit
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