Employee Payroll Direct Deposit Questions: 351-2700
Student Refund Direct Deposit Questions: 351-2821
Student Refund and Billing Questions: 351-4862 (Option 3)

Authorization Agreement for Automated Deposits -  US Financial Institution of Choice
New Authorization	Change of Account	Amount Change Only	Temporarily Cancel

Name_ 		 (Please Print)

Bear number  	

(Check One)	Student/TA/GA	Classified	University Aide/Technical Professional	Faculty/Exempt

UNC Department (if employee) _ 	

Daytime Phone No. 	

I hereby authorize the University of Northern Colorado to make payment of any amounts owed to me by initiating credit entries to the account listed below. I understand and agree that if an erroneous credit is made to my account that the University and financial institution are authorized to stop payment, reverse the entry, or make any adjustments necessary to my account to correct the erroneous entry. I understand that this authorization will remain in effect until I have cancelled it in writing.

If UNC is not notified two weeks prior to payday to prevent the direct deposit from occurring and funds are directed into a closed account, the direct deposit will reject at the financial institution. I understand that funds will not be available to me until the original funds are returned by the financial institution and a check can be prepared. I understand that I am responsible for checking the availability of funds in my account and that the University is not liable for check charges incurred before funds are verified.

If applicable, I hereby authorize net proceeds for Student Refund/Disbursements to automatically be deposited to the primary account listed below.

Signature  	

Date_ 	

Primary Account:	Checking	Savings
(Full amount of deposit if only primary account exists, and remaining balance of deposit if secondary account exists) Tape a VOIDED CHECK for the direct deposit account requested here.
•	Deposit slips are only allowed for savings accounts (only if t h e ro u tin g n u mb er d o es n o t b eg in with “5”) 
•	If you don’t use checks, ask your bank for a “Direct Deposit Letter” which would include the bank name, routing number, your account number and name.

If you are requesting funds be disbursed to someone else’s bank account, a memo must be submitted that states

“I hereby authorize UNC to distribute all funds to	_	(the other person’s name) and I hold the University harmless in submitting to another person.”

Secondary Account: (Payroll only!) specify an amount ($) or percent (%)	Amount /Percent	Savings	Checking

Tape a VOIDED CHECK for the direct deposit account requested here.

•	Deposit slips are only allowed for savings accounts (o n ly if t h e ro u tin g n u mb er d o es n o t b eg in with “5”) 
•	If you don’t use checks, ask your bank for a “Direct Deposit Letter” which would include the bank name, routing number, your account number and name.

If you are requesting funds be disbursed to someone else’s bank account, a memo must be submitted that states

“I hereby authorize UNC to distribute all funds to	(the other person’s name) and I hold the University harmless in submitting to another person.”

Submit this form back to the Payroll Office, Carter 2005, 501 20th Street, Campus Box 5, Greeley, CO 80639

L:\Payroll\Forms\Direct Deposit Rev 05012019