Fillable Student Employees ONLY - Direct Deposit Form I (Metropolitan State College of Denver)

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Student Employees ONLY - Direct Deposit Form I (Metropolitan State College of Denver)

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The Student Employees ONLY - Direct Deposit Form I (Metropolitan State College of Denver) form is 1 page long and contains:

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  • 2 check-boxes
  • 10 other fields

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File type: PDF

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Metropolitan State University of Denver
Student Employees ONLY - Direct Deposit Form
Rev 01/01/17
AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITS
I Accept Direct Deposit
(Must Complete All Information Below)
COMPANY NAME:
Metropolitan State University of
Denver
COMPANY ID
NUMBER:
84-0559160
I hereby authorize MSU Denver, hereinafter called COMPANY, to initiate credit entries and to initiate, if necessary, debit
entries and adjustments for any credit entries in error to my ( ) Checking ( ) Savings account (select one) indicated below at
the depository named below, hereinafter called DEPOSITORY, to credit and/or debit the same to such account.
BANK DEPOSITORY
NAME:
ROUTING NUMBER
ACCOUNT NUMBER
This authorization is to remain in full force and effect until COMPANY has received written notification from me of its
termination in such time and such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.
NAME
900 Number
(PLEASE PRINT)
Work Telephone Number:
Home/Cell Telephone
Number:
DATE
SIGNED
NOTE: ALL WRITTEN CREDIT AUTHORIZATIONS SHOULD PROVIDE THAT THE RECEIVER MAY
REVOKE THE AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR IN THE MANNER
SPECIFIED IN THE AUTHORIZATION.
ATTACH
Voided Personal Check or Banking Institutional Letter
HERE
I Decline Direct Deposit
(Paycheck available for pickup in the Cashiers
Office – Student Success Bldg.)
Print Name
900 #
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signature
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Student Employees ONLY - Direct Deposit Form I (Metropolitan State College of Denver)

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Completed 18 September 2020

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