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 the routing number does not begin 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 (only if the routing number does not begin 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.”

Payroll Office, Carter 3002, 501 20th Street, Campus Box 5, Greeley, CO 80639 or email: payroll.office@unco.edu

Student Refund - UNC Card Office, University Center, 501 20th Street, Campus Box 2, Greeley, CO 80639 or email card.office@unco.edu

L:\Payroll\Forms\Direct Deposit Rev 08012022