Direct Deposit Authorization

Ferris State University

Payroll Office, PRK 257

(231) 591-2160 Phone (231) 591-2975 Fax

Name_______________________________ Social Security Number________________

(please print)

Please check one: ___ Faculty/Staff ___ Student

Deposit ticket or voided check required

___New ___Change ___Stop Account Type: ___ Checking ___ Savings

Institution Name____________________________ ____ % of net check or $ ______

Bank Routing/Transit Number: ___ ___ ___ ___ ___ ___ ___ ___ ___

Account Number: _________________________ Institution phone #_____________

___New ___Change ___Stop Account Type: ___ Checking ___ Savings

Institution Name____________________________ ____ % of net check or $______

Bank Routing/Transit Number: ___ ___ ___ ___ ___ ___ ___ ___ ___

Account Number: _________________________ Institution phone #_____________

* NOTE: Direct deposits become effective the SECOND PAYCHECK after this

form is received by the FSU Payroll Office.
* When TRANSFERRING direct deposits between banks you will receive one “cashable check”

I authorize Ferris State University to start crediting my account(s) at the financial institution(s) listed above for the purpose of automatically depositing funds as indicted above.

I understand that if my account(s) at the financial institutions(s) listed above have been changed or closed, I must inform the FSU Payroll Office in writing. FSU is unable to refund rejected monies until they are credited to the FSU payroll account.

______________________________________________ __________________

Signature Date

________________________

Campus Phone