Form updated on August 21, 2020
Purchasing PO12
US SUPPLIER DIRECT DEPOSIT FORM
USD Direct Deposit/ACH (Automatic Clearing House) payments are available only for US Suppliers with a physical US address.
PO Box addresses will not be accepted. All payment information must be accompanied by a physical mailing address, per US
Federal Reserve regulations. All fields marked with * are mandatory and must be completed before submission.
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 file with your bank.
PO Box addresses will not be accepted. All payment information must be accompanied by a physical mailing address, per US Federal
Reserve regulations.
Company or Individual Name*:
Contact Name*:
Telephone*:
Email for Payment Remittance Notice*:
Address*:
City*: State*:
Country*: Zip Code*:
Banking Information
You must attach a void cheque or letter of guarantee from the bank. All information below, including the ABA Routing number,
Account Number and Bank Name must be provided.
Bank Name *:
Bank Account Number *:
ABA Routing Number *:
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. A hand written or digitally verified signature is required (not typed or signature font).
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.
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signature
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