Vendor ACH/Direct Deposit Authorization Form
University of San Diego Office of Accounts Payable
1. Please Check One:
NEW Direct Deposit CHANGE Direct Deposit CANCEL Direct Deposit
2. Vendor/Payee Information
Contact Person’s Name (if other than payee):
Telephone Number:
Email Address:
3. Financial Institution Information
Bank Name:
Bank Address:
Name on Bank Account:
Bank Account Number:
Nine-Digit Bank Routing/Transit Number (ABA):
Type of Account: Checking Savings
4. Approvals/Authorizations -
I certify that the information provided on this form is correct, and I hereby authorize University of San Diego Office of
Accounts Payable to electronically deposit payments to the bank account designated above. It is my responsibility to notify USD AP ( or (619)
2604732) immediately if I believe there is a discrepancy between the amount deposited to my bank account and the amount of the invoice(s) paid. I understand
that I must notify USD AP in writing immediately of any changes in status or banking information. I understand that this authorization will remain in full force and
effect until USD AP has received written notification requesting a change or cancellation and has had reasonable opportunity to act on it, which should take no
longer than seven (7) to ten (10) business days.
Print Name:________________________________ Signature:_________________________ Date:_______________
Important Information
Please return completed form via email:
For Office of Accounts Payable Use Only
Date Stamp - Received
AP Reviewed and Approved:
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