Please select one of the following:
New Change Cancel
Student Direct Deposit Authorization Form
St
udent Name: ________________________________ Student ID: _____________________________
Daytime Phone: _______________________________ Email: ___________________________________
Bank Name: __________________________________ Type: Checking Savings
*Routing Number: _____________________________ *Account Number: _______________________
I understand that:
Direct deposit transactions will be sent to the bank.
I should contact my financial institute to verify receipt of funds.
I should always review my pay stub on
The Hub
under the Timecards option.
I authorize Hampshire College to deposit my paycheck directly to the account above, and to correct any errors that
may occur from these transactions. I authorize the financial institution indicated above to post transactions to the
account. I understand that this process may take up to two pay cycles to take effect. This agreement is to remain in
effect until Hampshire College receives written notice from me to cancel or change this authorization. I understand
that Hampshire College is not responsible for bank errors.
S
tudent Signature: ________________________________________ Date: ____________________________
Please attach a voided check or direct deposit form from your bank if available
Please return this form to the Payroll Office which is located in Blair Hall, second floor, room 217. The
hours of operation are Monday through Friday 8:30AM-4:30PM (closed 12:00PM 1:00PM)
Routing Number
Account Number
*Note: Failure to supply the correct Routing Number and/or Account Number will cause a delay in the process.
Please sign with Pen
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