"Direct Deposit TEMPLATE"
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