HR Direct Deposit Authorization Form

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Academic Affairs
College of Saint Mary
7000 Mercy Road
Omaha, Neb. 68106
academicaffairs@csm.edu

payroll direct deposit authorization agreement form

To enroll in Full Service Direct Deposit, simply fill out this form and give to the Office of Academic Affairs. If depositing to a savings account, ask your bank to give you the Routing/Transit ABA Number for your account. It isn’t always the same number as on a savings deposit slip. This will help ensure that you are paid correctly. If you have any questions while completing this form please contact the Office of Academic Affairs at the information above.

Bank Name

Account #

9 Digit ABA
Routing #

Checking or
Savings

Deposit
Amount

Any additional notes:

If you choose, you can upload an image of a voided check for accuracy. It is not required.

Voided Check:

Important! Please read and sign before completing and submitting.

I hereby authorize ADP (Automatic Data Processing, Inc) to deposit any amounts owed me, as instructed by my employer, by initiation credit entries to my accounts at the financial instructions indicated on this form. Further, I authorize the financial institutions to accept and to credit any credit entries indicated by ADP to my accounts. If funds to which I am not entitled are deposited to my account, I authorize ADP to direct the bank to return said funds to ADP.

This authorization is to remain in full force and effect until ADP and the financial institution have received written notice from me or notice from the HR Director of its termination in such a manner as to afford ADP and the financial institution opportunity to act on it.

First Name:

Last Name:

Date:

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