DIRECT DEPOSIT AUTHORIZATION FORM

Bank #1 Information: Account specification sheet (which can be obtained from your bank) must be included with this form

Bank Name: ______

ABA Routing Number ______Account Number: ______

____ Savings Account _____ Checking Account (Check One) Amount to Deposit $______or Net Check

Bank #2 Information: Account specification sheet (which can be obtained from your bank) must be included with this form

Bank Name: ______

ABA Routing Number ______Account Number: ______

____ Savings Account _____ Checking Account (Check One) Amount to Deposit $______or Net Check

Bank #3 Information: Account specification sheet (which can be obtained from your bank) must be included with this form

Bank Name: ______

ABA Routing Number ______Account Number: ______

____ Savings Account _____ Checking Account (Check One) Amount to Deposit $______or Net Check

I hereby authorize and request the University of New Haven, hereinafter called University, to make payment of any amounts owing to me for Payroll by initiating credit entries to my account indicated below in the bank named below, hereinafter called Bank, and I authorize and request Bank to accept any credit entries initiated by University to such account and to credit the same to such account without responsibility for the correctness thereof. I also authorize the University to enter a debit to my account in the following circumstances and under the following conditions: The debit entry is initiated for the purpose of correcting an erroneous credit previously initiated to my account. The correcting entry is transmitted in such time as to be delivered or made available to Bank by midnight of the fifth day next following settlement to the erroneous entry, and, prior to the time the correcting entry is initiated, the University has sent or delivered to me written notification of such correction and the reason therefore. It is understood that I may terminate this agreement at any time by written notification to the University or Bank. Any such notification to the University shall be effective only with respect to entries initiated by the University after receipt of such notification and a reasonable opportunity to act on it. Any such notification to Bank shall be effective only with respect to entries credited to my account by Bank after receipt of such notification and a reasonable time to act on it.

Signature: ______Date: ______NOTE: NEW DIRECT DEPOSITS MUST TEST FOR 1 ACTUAL PAY BEFORE BECOMING EFFECTIVE NOTE: NEW DIRECT DEPOSITS MUST TEST FOR 1 ACTUAL PAY BEFORE BECOMING EFFECTIVE