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									          FLORIDA AGRICULTURAL AND                                                                        Please Read And Carefully Follow Instructions!
            MECHANICAL UNIVERSITY
                                                                                                                For a NEW or CHANGE, please fill in as appropriate.
        EMPLOYEE DIRECT DEPOSIT AUTHORIZATION
                                                                                            This form will start, change, or stop direct deposit for all payments received by you
                                                                                            from Florida A&M University. You may have direct deposit to more than one account.
                                                                                            If you select to have more than one direct deposit, you are required to complete this
                    PLEASE PRINT OR TYPE CLEARLY                                            form twice. If you are changing your direct deposit, you are required to complete all
                                                                                            sections in the FROM and TO boxes
                           New or Change                                                    Name: Please be sure your last name on this form matches the last name on your
Your Social Security Number                                                                 W-4 and Social Security Card on file with our Personnel Office. Your direct deposit
                                                                                            will not start if the last names do not match. If you change your last name on your
                                                                                            W-4, you also must change your last name for direct deposit. You may fax a copy
Last Name,                      First Name               M.I.                               of signed, revised W-4 and Social Security Card to the number on th first page to
                                                                                            make the change.

Your Home Mailing Address (Number, Street)



City                                                                                                                     Direct Deposit Action Requested:
                                                                                            1. Check Start if you don’t have direct deposit and wish to.
State                                                   Zip Code                            2. Check Change if you have direct deposit and wish to change your financial institution or
                                                                                            just your account type (Checking or Savings). Your current direct deposit is stopped when a
                                                                                            change request is received. While the change is being processed, you will be paid by
                                                                                            warrant (check).
                                                                                            3. Check Stop if you wish to stop your direct deposit. Stops are processed the day they are
Home Telephone                                           Other Telephone (work,cell,etc.)   received.
                                                                                            4. Check Name Change Only if you are changing only your name to correspond to your W-
                                                                                            4 and Social Security Card. Complete the top portion of the form and sign and date it.
                                           1) Start ------------------------
    Direct Deposit Action
                                           2) Change ---------------------                                                         Account Type
   Requested (Check Only
                                           3) Stop ------------------------                 1) Checking if you wish your direct deposit to go to your checking account.
            One)
                                           4) Name Change Only -------                      2) Savings if you wish your direct deposit to go to your savings account.
 Account Type (Check Only                  1) Checking -------------------
           One)                            2) Savings --------------------                                                        Distibution Type

                                               a) Percent -----                             a) Percentage if you choose percentage, please use who numbers. (i.e. 50% or 1%)
 Distribution Type (Check or
                                               b) Amount. ----                              b) Amount if you choose flat amount. Please use who dollar. (i.e. $500 or $12)
       Type Only One)
                                               c) Balance -----                             c) Balance if you choose balance, please check the box only.
NEW or FROM -Your Account Number - Start at left, leave unused spaces blank.



                                                                                            Account Number: Please make sure the account number written on this form is
TO - Your Account Number - Start at left, leave unused spaces blank.
                                                                                            correct. If you’re not sure, Please Contact Your Financial Institution


NEW or FROM - Transit Routing Number of Your Financial Institution.                         Transit Routing Number: This is the nine digit number that identifies your financial
                                                                                            institution (Bank, Savings and Loan or Credit Union) . It is found in the bottom left-
                                                                                            hand corner of your personal check.
TO - Transit Routing Number of Your Financial Institution.

                                                                                                                                     Agreement

NEW or FROM - Name of Your Financial Institution.                                           I hereby authorize and request Florida A&M University to initiate credit entries and, if
                                                                                            necessary, a debit entry in accordance with NACHA rules reversing a credit entry
                                                                                            made in error, to my account at the financial institution named. This direct deposit is
TO - Name of Your Financial Institution.                                                    to remain in effect until withdrawn by: (a) me in writing with sufficient notice to Florida
                                                                                            A&M University to allow adequate time to effect termination; (b) my death or legal
                                                                                            incapacity; (c) the financial institution or (d) Florida A&M University. It will purge
NEW or FROM - Telephone Number of Your Financial Institution.                               approximately six (6) months after my last wage.

                                                                                            Special Note: Please make sure your direct deposit has stopped before closing your
TO - Telephone Number of Your Financial Institution.
                                                                                            account. Otherwise, the funds will be returned to Florida A&M University and cause a seven
                                                                                            to ten day delay before you receive your salary or supplemental payment in the mail.
NEW or FROM - Employee or Legal Representative Signature                 Date
                                                                                               Forms with deposit slips attached will be rejected; the banking codes are not correct.
TO - Employee or Legal Representative Signature            Date
                                                                                               Tape a voided personal check here for verification. If a savings account, please verify
                                                                                                               account information with your financial Institution.


            THIS FORM MUST BE SIGNED AND DATED BY PAYEE. Please allow 1 to 2 weeks for your direct deposit to begin.
                      Signature above signifies acceptance of the terms and conditions in AGREEMENT above.
                    Employees may view salary payments at https://our.famu.edu/psp/aprdep/EMPLOYEE/EMPL/h/

                      Mail to: Human Resources
                        Florida A&M University                                                                             Contact:
                 211 Foote-Hilyer Administration Center                                                  Telephone (850) 599-3611, Fax (850) 561-2080
                       Tallahassee, FL. 32307

								
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