<p> Direct Deposit Enrollment Form</p><p>As a convenience to faculty, staff, and student staff members, and to promote sustainability and cost- effectiveness, Puget Sound makes payroll payments by direct deposit to banking/credit union (financial) institutions that are members of the Automated Clearing House (ACH).</p><p>Please complete, sign, and return this form to the payroll office in Howarth Hall Room 016. We welcome your questions. Contact us at 253.879.2841; campus extension 2841; or [email protected].</p><p>I would like Direct Deposit to my account(s) listed below. For each account listed, attach a voided check or a form from your financial institution listing the routing number and account number (online accounts). Primary Account* Financial Institution: Routing Number: All*/Balance of my check Account Number: Check one: Checking Savings *non-payroll payments will be deposited into the Primary Account in full. Additional Accounts: To deposit a portion of your payroll payment to another account, complete the following section. Financial Institution: Routing Number: Exact Amount: $ Account Number: Check one: Checking Savings Financial Institution: Routing Number: Exact Amount: $ Account Number: Check one: Checking Savings Financial Institution: Routing Number: Exact Amount: $ Account Number: Check one: Checking Savings Direct Deposit Authorization and Acceptance Please read, complete, and sign this section. I authorize The University of Puget Sound (“Puget Sound”) to initiate electronic credit entries (direct deposit) and if necessary, adjustments (debit entries) for any direct deposit amounts in error, to the financial institution account(s) identified above. I agree not to hold Puget Sound responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. This agreement will remain in effect until I submit a new electronic payment authorization form to the payroll office or the payroll office has received written notification from me of its termination in such time as to afford a reasonable opportunity to act. This agreement may end at the discretion of Puget Sound.</p><p>Print Name: Check one: Faculty/Staff Student </p><p>Puget Sound ID (if known): Contact Phone: () -</p><p>Signature: Date: </p><p>016a5e95edd6533540d23f48e86bb575.docx Page 1 of 1</p>