Authorization for Direct Deposit

The University Of Memphis Operating Policy No. UM1341 provides additional information for completing this form.

Name: Banner UID
Dept:

Primary Account-Direct Deposit NET PAY Amount
	Name of Bank:
	Bank Routing Number:
	Account Number:
	Type of Account:	Checking Savings

Secondary Account-Direct Deposit FIXED DOLLAR Amount
	Name of Bank:
	Bank Routing Number:
	Account Number:
	Fixed Dollar Amount $:
	Type of Account:	Checking Savings

Third Account-Direct Deposit FIXED DOLLAR Amount
	Name of Bank:
	Bank Routing Number:
	Account Number:
	Fixed Dollar Amount $:
	Type of Account:	Checking Savings

Bi-Weekly paid Monthly paid Check if this is a change

I hereby authorize The University of Memphis to direct the net amount and/or fixed dollar amount of my salary and wage payments to my bank account(s) as shown above, effective on the next payroll possible. A preprinted deposit slip or voided check is attached for verification purposes. This authorization is not an assignment of my right to receive payment and revokes all prior payment direction notifications applicable to these payments. I understand that this request may be cancelled or changed by me upon proper execution of another authorization agreement. I also understand that this authorization may be terminated at any time by the University, or named bank. I authorize The University of Memphis to initiate withdrawal transactions from my account in the event of an overpayment or erroneous deposit.

Employee Signature_______________________________ Date____________

The University of Memphis is an Equal Opportunity/Affirmative Action University.
It is committed to education of non-racially identifiable student body.