I hereby authorize The University of Memphis to direct the fixed dollar amount
of my salary and wage payments to my bank account(s) as shown above, effective on the next payroll possible. A
payroll authorization form from TN Stars 529 MUST be attached to this form 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.
I understand this authorization applies only to my payroll record and does
not affect my vendor record direct deposit (ACH) information.
Employee Signature_______________________________ Date____________