Company/Entity Name:
One of the following MUST be provided in order to process this form:
A Number: Recent PO Number:
Tax ID Number:
Account Type: Checking Savings
Bank/Financial Institution:
Routing Number: Account Number:
Company Representative Printed
Company Representative Signature Date
Vendor Direct Deposit Enrollment For
Instructions: Fill out form in its entirety. Submit via email to
Authorization Agreement
Account Information
I hereby authorize Alabama Agricultural and Mechanical University to direct deposit my payments to my financial
institution(s) listed below until I terminate this agreement in writing. A terminated or new agreement shall become
effective within one week following receipt of this form.
In the event that funds are erroneously deposited into my account(s), I authorize Alabama Agricultural and
Mechanical University or the depository institution to debit my account for the purpose of correcting the error.
I acknowledge that:
(1) It is my responsibility to verify my a
ccount balance prior to making disbursements or withdrawals.
(2) Al
abama A&M University assumes no liability for bank errors, bank fees, or overdrafts.
(3) Deposit rejections will not be reprocessed until funds ha
ve been redeposited into the University's account.
(4) A
new authorization must be completed when changing accounts or financial institutions, or when closing an
I certify that the information provided on this form is correct and that I am authorized to execute this document.
Revised 04/2020
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