Fillable Student Direct Deposit Authorization Form (Umpqua Community College)

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Student Direct Deposit Authorization Form (Umpqua Community College)

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The Student Direct Deposit Authorization Form (Umpqua Community College) form is 1 page long and contains:

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  • 5 check-boxes
  • 12 other fields

Country of origin: US
File type: PDF

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Name:
First MI Last
FINANCIAL AID / ACCOUNTS PAYABLE
Checking Savings
Start Change Cancel
City, State, Zip:
Printed Name Signature
Date
This agreement will remain in effect until Umpqua Community College receives a written notice of cancellation from me or my
financial institution, or until I submit a new direct deposit form to the Finance Office. Please allow the College ten business days for any
changes to this information.
AUTHORIZATIONANDCERTIFICATIONSIGNATURES:
RoutingNumbers TypeofAccountTypeofTransaction
I hereby authorize Umpqua Community College to deposit my financial aid/accounts payable funds into my account at the bank
named above. Umpqua Community College is authorized to reverse any deposits made in error to my account through the college's direct
deposit program. I further warrant that I am a holder on the account listed above.
Finance Office Use: Id verified
Student Direct Deposit Authorization Form
Financial Aid & Accounts Payable Disbursements
Directdepositistheprocesswherebythecollegedepositsyourfinancialaidorotherreimbursementdirectlyintothesavingsorcheckingaccountofyourchoice.
FilloutthedirectdepositformbelowandreturnittotheFinanceOffice,orcall(541)440‐4630formoreinformation.DirectDepositis
free.Pleaseallowprocessingtimeasyouraccountinformationmustbeverifiedwithyourfinancialinstitutionbeforeyourrefundcanbe
deposited.DirectDepositForms,andaca
nceledcheckordirec
tdepositpaymentauthorizationfromyourbankmustbereturned,in
person,totheFinanceOfficelocatedinLAVERNE MURPHY Student Center, 1140 Umpqua
CollegeRd,Roseburg, OR 97470.
Social Se
curity Number
Student Banner ID number (required)
Phone number
Pleasenote:PHOTOIDREQUIREDTOSUBMITFORM
Further, I agree not to hold Umpqua Community College responsible for any delay or loss of funds due to incorrect or incomplete
information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my
account.
Financial Institution:
Accountnumber
Revised08/2017
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Student Direct Deposit Authorization Form (Umpqua Community College)

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Completed 3 October 2020

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